1 LIBRARY OF CONGRESS. 9 



3a. V\^ 




TO 



QUINTON GIBBON, M. D 



THIS WORK IS RESPECTFULLY DEDICATED 



THE AUTHOR. 



dA 



PRACTICAL TREATISE 



ON THE OPERATIONS 



OF 



SURGICAL AND MECHANICAL 



DENTISTRY. 



BY SAMUEL C. HARBERT, 

SURGEON DENTIST. 



Tu rem irapeditam et perditum reslituas." — Terence. 



PHILADELPHIA : 

BARRETT & JONES, PRINTERS, 34 CARTERS ALLEY. 

18-17. 



1^ 






Entered according to Act of Congress, in the year 1847, 

BY DR. SAMUEL C. HARBERT, 

In the Clerk's Office of the District Court of the Eastern District of 
Pennsylvania. 



CONTENTS. 



PART FIRST. 

DENTAL SURGERY. 

CHAPTER I. 

Page 

The History and Importance of the Dental Art, - - - - 11 

The Necessity of a Proper Regard to the Health and Permanency of the 

Teeth, - 13 

Mastication, .... IQ 

The Anatomy and Physiology of the Teeth, .... 17 

CHAPTER II. • 

First Dentition, - - - - - - - - - -23 

Second Dentition, - ■ - - - -- - - - 27 

Third Dentition, - - - - . - - - - 32 

Irregularity of the Teeth, - - - - - -- 35 

Treatment of Irregularity, --------38 

CHAPTER III. 

Caries of the Teeth, -.---___ 42 

Cause of Caries, ------- - . 46 

Tartar, 50 

The Effect of Tobacco on the Teeth, ------ 53 

The Effect of Mercury on the Teeth, 56 



VI 



CONTENTS. 



CHAPTER IV. 

Tagc 
Treatment of Caries, ---------58 

Filing of Teeth, 59 

Filling of Teeth, 62 

Scaling of Teeth, ---.----- 71 



CHAPTER V. 

Odontalgia, ----------75 

Extracting of Teeth, - 79 

The Lancet, 80 

The Key, 82 

The Forceps, ... 89 

The Punch, 93 

The Screw, - - ... 94 

The Thumb-Fulcrum, 94 

Excessive Hemorrhage from Extraction, - - - - 95 



CHAPTER VI. 



Exostosis of the Fangs of the Teeth, 
The Denudation of the Enamel, 
Necrosis of the Teeth, 
Diseases of the Gums, 



99 
100 
103 
104 



CHAPTER VII. 



Preparation of the Mouth Previous to the Insertion of Artificial Teeth, 110 
Engrafting of Teeth, .._----- H4 

Process of Engrafting, - - - - - - - -117 

Tooth Powders, '" - 121 

Orris Tooth Paste, - - - 122 



CONTENTS. 

MECHANICAL DENTISTRY. 

CHAPTER I. 

Page 

Mechanical Dentistry, --------- 125 

Teeth Made from the Tusks of the Elephant or Teeth of the Hippo- 
potamus, .----...- 128 

Teeth Made from those of Cows and Sheep, ... - - 129 

Teeth Made from Human Teeth, ------ 131 

Teeth Made from Porcelain, ----- - 132 

CHAPTER II. 

The History and Composition of Porcelain Teeth, ... 134 

Fell-Spar, - - - 138 

Kaolin or Porcelain Clay, ------- 140 

Silex, 141 

CHAPTER III. 

Coloring Principles of Porcelain, ------ 142 

Oxide of Gold, 143 

Platina, - .146 

Titanium, 147 

Zaffre, 148 

Uranium, - - - - 149 

Nickle, 149 

CHAPTER IV. 

Formulas, _...---.-- 150 

Opaque Paste, - - - - - - . - - . - 150 

Translucent Paste, ;-------- loO 

Enamels, ---------- lol 

Enamel for Gum, ------- -10- 



Vlll CONTENTS. 

CHAPTER V. 

Page 

Moulding of Porcelain Teeth, ------- 154 

Articulator)-- Guides, - - - -- - - - - 155 

Carving of Porcelain, --------- 15(; 

Enamelling, -'- - - - - - - - -159- 

Baking of Porcelain Teeth, ------- 16Q 

CHAPTER VI. 

Plates for Mounting Porcelain Teeth, ------ 162 

Ligatures, --._.-.--. 107 

Selection of Porcelain Teeth, - - - - - - - 168 

Fitting of Porcelain Teeth, -------- 169 

Finishing of Plates, - -- - - - - - 172 

CHAPTER VII. 

Soldering, - - - - - - - - -'- 173 

Gold, - - 175 

Melting and Refining Gold. 177 

Separation of Gold and Silver from Impurities by Amalgamation. - 178 

Table of Alloys, 180 

Solder, .--..----- 1S2 

Milling of Gold and Silver, -------- 1S4 

To Make Spiral Springs, ....--. 185 

CHAPTER VIII. 

To Make a Transfer of the Mouth, 188 

To Make a Plaster Model, ------- 190 

To Make Metallic Dies and Cast, ------- 191 

CHAPTER IX. 

Hand Lathe, 193 

Platina Shears, ---------- 194 

Hydrostatic Air Pipe, - - - . - - - - - 195 

Emory Wheels, ---------- 196 

Manner of Making Moulds, 198 

CONCLUDING REMARKS. 

Empiricism — The Letheon — Reproduction of Osseous Matter — The Liga- 

mentum Dentium — Conclusion, ------ 200 



Tlate I 



Esi 



jfy.f. 



If 



Fig. 2. 



m I 



ssi«&Ki&£s;:;- Aiii- .-:kJ$ 



Fig. 3. 





FUj.4: 



:--'~-^r---'-- ■':•■- - ,:.;:■. ;.--.- ;..;..:■. : i : _.:. 









Plate IT. 




Plato m. 






UBS 




Plate IK 



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Fig. 




PREFACE. 



The Science of Dentistry has, in accordance with the 
advancement of the art, become divided into two separate 
branches : that of Dental Surgery appertaining to the opera- 
tions on the teeth in their natural condition ; and the 
mechanical, or that part which provides a substitute for the 
deficiencies that occur in nature. 

Several useful works have been published on the opera- 
tions of Dental Surgery, while the mechanical department, 
as yet in its infancy, has received but little notice. The 
manipulations and valuable formulas, essential to the 
proper performance of the art, have been almost universally 
held under the seal of secrecy, so that but little becomes 
known except it be acquired by actual experiment. Many 
recent discoveries and improvements have conduced to its 
importance and usefulness. 

It was designed, in the publication of this volume, to 
endeavor to fill an existing void in the mechanical part of 
dental practice, and, at the same time, to aid the practitioner 
in Dental Surgery by means of the author's experience and 
research. That nothing more remains to be learned, or that 
the author has revealed all the known facilities of the art, 
he does not pretend, but, in the general principles, he has 
striven to impart, from his own practice, all he considers 
important and useful, which, with the judgment and skill 
of the artizan, he hopes will prove an important auxiliary 
in the duties of the office and laboratory. 

With regard to a full and explicit execution of purpose, 
2 9 



X PREFACE. 

more attention has been paid to perspicuity of style and 
manner, than elegance of diction or perfection of lan- 
guage. A life of practical experience, exercised with the 
growing operations of the art, and in the theatre of its 
most successful experiments, form the basis of the writer's 
resources, from which he has drawn liberally and unre- 
servedly, withholding nothing he considered important in 
the prosecution of the dental art, and advancing no specu- 
lative theories calculated to deceive or bewilder the 
operator. 

To a more thorough knowledge of the pathology and 
physiology of the teeth, together with the anatomical struc- 
ture of the system, or that part upon which the functions of 
the teeth depend, the student is referred to some of the 
many and valuable publications extant ; as this work was 
not designed for such a purpose, it will be found inadequate 
to a thorough acquirement of it. 



DENTAL SURGERY. 



CHAPTER I. 

THE HISTORY AND IMPORTANCE OF THE 

DENTAL ART. 

The necessity of knowledge in the anatomical structure 
and organization of the teeth, and the treatment of diseases 
to which they are subject, are matters of more importance 
than would be inferred from the practice of a majority of 
dental operators, who, content with the merest exhibition of 
mechanical ingenuity, and more frequently depending upon 
the assistance of adjuvants to the profession, without refer- 
ence to the physiological laws that reflect upon diseases of 
the teeth, operate in all cases alike, and determine the fate 
of an unhealthy organ, by filling or extracting it, sometimes 
to the serious inconvenience and comfort of the patient, or 
to the actual loss of a valuable member, that might have 
been, by judicious treatment, preserved for life. 

It is a lamentable fact, that the dental profession is, to a 
considerable extent, in the hands of charlatans and impos- 
ters, who willingly sacrifice every principle of honor to the 
prosecution of their deceptions, and their own aggrandize- 
ment. No penal enactments can reach them, and by their 
insidious arts and schemes, they conceal the real character 
of their operations until too late to avoid them. 



12 DENTAL SURGERY. 

These remarks, of course, are not designed to apply to 
the mass of dental operators ; such a declaration would be 
the supremacy of folly and injustice. The superior qualifica- 
tions and eminent abilities of a host of practitioners, in 
this and other countries, are too well established to be 
effected by the mere exposition of a common evil. 

A ray of hope has dawned upon the dental art in this 
country, by the establishment of collegiate institutions in 
the cities of Baltimore and Philadelphia. I am aware, 
though I regret the fact, that a great amount of jealousy 
exists in the fraternity, which circumstance must necessarily 
retard the operations of a dental institute ; but the object 
and the effect of such institutions cannot fail to eventually 
awaken a proper spirit of interest and liberality of feeling, 
and give an impulse to the profession which will elevate it 
to a position equal to its kindred art, that of medicine ; 
with such a prospect only, can a hope be cherished of relief 
from the flood of empiricism by which this country is 
deluged. 

The science of dentistry has made but a slothful progres- 
sion when compared with other arts ; that it attracted the 
attention of the ancients is evident from the writings of 
Hippocrates, the most eminent of ancient physicians, and 
who was considered the father of medical science. He 
was born 460, B. C. In his writings he treated of the 
diseases and functions of the teeth. Celsus, a Roman 
physician, of the Cornelian family, who lived under the 
reigns of Augustus Tiberius and Caligula, was born either at 
Rome or Verona. He wrote various works, but his Treatise 
on Medicine, in eight volumes, was his chief production. 



PERMANENCY OF THE TEETH. 13 

Therein he also referred to the diseases of the teeth and 
their remedies. The works of many other celebrated 
physicians of antiquity, from their time, have established 
the fact that the teeth have received the notice and atten- 
tion they were capable of, but not with the same degree of 
excellence and perfection of art of later years. 



THE NECESSITY OF A PROPER REGARD TO THE 
HEALTH AND PERMANENCY OF THE TEETH. 

The value of the teeth as auxiliaries to the support of 
life, is seldom fully understood or justly appreciated. 
Nature has endowed man with certain faculties, perform- 
ing specific and positive functions — the destruction or inca- 
pacity of either must produce injury, in a corresponding 
degree, to the physical or mental structures ; among the 
most valuable and important of which are the teeth, a sett 
of nicely adapted organs, designed for the comminution of 
food, preparatory to its reception into the stomach, and for 
the formation and articulation of words. They are, not- 
withstanding their silicious structure, constantly liable to 
disease, and in that condition exercise a varied and inju- 
rious influence on the general health — first, by preventing 
or interfering with the mastication of food ; secondly, by 
exciting the nervous system ; thirdly, the vitiating effect 
which they impart to the atmosphere inhaled into the 
delicate structure of the lungs ; and, fourthly, their sympa- 
thetic influence upon the gums. The necessity of a proper 

division of the food, to prepare it for the action of the 
1* 



14 DENTAL SURGERY. 

gastric juice, is evident from the numerous experiments 
that have been made, many of which have been conclusive 
and satisfactory. 

The effect of an aching tooth upon the nervous system, 
has been expeiienced by almost every one that has 
attained to mature age ; few, indeed, escape its torturing in- 
fluence — and such as have endured, can testify to the aching 
head, and violent pains in the face and jaw, occasioned by 
it. Diseases of the lungs may be frequently traced to the 
inhalation of an impure air, and no more immediate or ac- 
tive medium can exist than a canal lined with carious teeth, 
filled with putrid matter. The healthy condition of the 
teeth and gums depend reciprocally upon each other : 
disease in the one produces a corresponding effect in the 
other ; pain in the teeth causes inflammation in the gums 
with all its resulting evils. " Abscesses of a serious 
nature are frequently produced in the gums by cold striking 
against the nerve of a decayed tooth. This state of things 
is not unfrequently characterised by severe general symp- 
toms, such as pain, first centered in the gum, extending 
itself to the eye, nose and ears ; headache, restlessness, 
catarrh, cough, occasionally diarrhoea and dysentery ; de- 
jection and oppression of spirits, fever, unusual irritability, 
furred tongue, spasms, fits and convulsions ; in females, 
high fever and delirium." Tumors, scurvy, sponginess 
of the gums, and a variety of other affections, that exercise 
an injurious tendency upon other parts of the system, may 
be frequently referred to decayed teeth. 

A French writer has said, " A mouth without teeth is a 
mouth with charms." If such an hypothesis is correct 



PERMANENCY OF THE TEETH. 15 

and who can'doubt it, we have, independent of all other 
motives, a sufficient one to induce a proper care of the 
teeth, for with the decay or loss of any one a proportionate 
arrival to such a condition is effected, and the first, if 
not the greatest part of female beauty is destroyed ; again, 
a pleasing countenance meets the eye, and we are almost 
led to exclaim "how beautiful." She smiles, and all our 
raptures vanish before an array of diseased and blackened 
teeth, or, perchance, a breeze wafts to our sensitive olfacto- 
ries a breath contaminated by the unwholesome medium, 
and we turn away sickened and disgusted. The savages 
teach a lesson in the care and attention they bestow on 
their own teeth, though the peculiar operations they per- 
form on their masticators are by no means worthy of imita- 
tion. The following remarkable instance of a disregard of 
the value of the teeth, appeared in evidence of the aban- 
doned and intemperate character of a woman ; for the 
credit of human nature such instances of depravity are 
seldom met with. 

After making way with all her substance, and being 
without the means of procuring drink, she actually sold 
all her teeth but two, to procure her favorite beverage, 
gin. The price she received was fourpence each. 

History tells us that the teeth were regarded in ancient 
times as a feature of beauty. Ovid says: — 

" Let not the nymph with laughter much abound, 
Whose teeth are black, unseemly, or unsound.' ' 

Cicero compared the teeth with the strings of an instru- 
ment, which modify the sound. Indeed every evidence is 
presented to us of their usefulness, and the necessity of 
proper skill in the culture of them. 



16 DENTAL SURGERY. 



MASTICATION. 



Masticate is derived from the Latin verb mando, sig- 
nifying to chew or grind with the teeth. 

The process of Mastication is performed with the aid of 
the muscles of the lower jaw, by which the food is cut off 
by the incisores, and carried back to be divided and reduced 
to a state of comminution ; through the action of the molars, 
it is then prepared for deglutition, and final reception into 
the stomach. 

"No one can enjoy health, unless the digestive process 
is well performed, and as an indispensable preliminary to 
perfect digestion, the food must be thoroughly masticated, 
finely divided by the teeth, the organs provided by nature 
for that purpose, or by some artificial means ; it is therefore 
important our meals should not be swallowed in haste, for 
it is absolutely impossible that food can be prepared to 
enter the stomach with the rapidity that meals are generally 
dispatched at our large boarding houses. Eating in haste 
causes more dyspepsia than error in quantity or quality of 
food ; besides it shows too much of the animal in our na- 
ture, a kind of greediness that may, with propriety, be dis- 
pensed with. The Americans are very generally and very 
justly, too, accused by other nations of being unsocial at 
their meals ; of making it a business, and dispatching it as 
if it were an unpleasant task ; sociability at meals tends to 
a good effect in two ways ; first, by protracting the time, 
we eat much slower ; and, second, by cheerful conversation 
the due performance of digestion is greatly facilitated." 

In consequence of the necessity of having the food tho- 



THE ANATOMY OF THE TEETH. 17 

roughly chewed, those who have bad teeth are peculiarly 
liable to derangement of the digestive organs, but since the 
science of Dentistry has attained to the perfection it has, 
most people have within their reach the means of supplying 
themselves with artificial teeth, answering very well all the 
purposes of mastication. 

Dr. Beaumont in his experiments, introduced different 
articles of food directly through an orifice in the side into 
the stomach of a young man, upon whom he experimented ; 
and he says, " that the process of mastication, insalivation, 
and deglutition, in an abstract point of view, do not in any 
way affect the digestion of food ; or, in other w r ords, when 
food is introduced directly in the stomach, in a finely divided 
state, without these previous steps, it is as readily, and as 
perfectly digested, as when they have been taken," thus 
exhibiting the necessity of comminution or mastication 
alone to the proper digestion of food. 



t THE ANATOMY AND PHYSIOLOGY OF THE 

TEETH. 

The teeth differ in their organization from the other bones 
of the system ; they are composed of two distinct substances, 
the body, or bone of the tooth, which is vascular and 
extremely sensitive ; and the enamel or that portion which 
covers the crown of the tooth, and serves as a protection 
for it from the effect of external action. Anatomically, the 



18 



DENTAL SURGERY. 



tooth is divided in two parts ; the crown being the ex- 
posed part, and the fang or root, situated in cavities, in the 
upper and lower maxilla?, called alveolar processes, between 
the edges of the alveolar and distinct line of division ; 
between the fang and crown, the gum is attached. The 
teeth are held in their sockets by the intervention of a 
membrane which embraces the roots and is firmly attached 
to the gum at the neck of the tooth — called the periosteum ; 
this membrane exercises an influence upon the permanency 
of the tooth, and its retention in the socket that demands 
for it a remedy against the causes that lead to its destruc- 
tion ; as it is supported by vessels leading from the gums, 
care is requisite to keep them in a constant state of health, 
otherwise teeth that are perfectly sound being deprived of 
the means of nourishment and support, may fall victims to 
a disease of apparently less consequence than that of caries. 
The body of a tooth in a healthy state is of an opaque 
slightly yellow color, and the enamel of a bluish white 
appearance ; sometimes the enamel inclines more to the 
yellow, and frequently both colors are found blended on 
the same tooth, the yellow next the gum and the blue near 
the cutting edge ; the deep yellow or green found on teeth, 
generally is attributable to depositions of salivary calculus ; 
the incisors are mostly of a lighter shade than the other 
teeth. The seed of the teeth is a mucous matter like 
albumen deposited in the cells of the jaw bone, and con- 
tinues to grow until it obtrudes through the gum. The 
rudiments of two setts are found very early in the foetus. 
Mr. Bell thus describes that very curious process, " About 
two months after conception, if the jaws be examined with 



THE ANATOMY OF THE TEETH. 19 

care, an extremely soft jelly-like substance is found lying 
along the edge of each maxillary arch. At the third month 
this has assumed rather a firmer consistence, and contained 
within a shallow groove of bone, which constitute the first 
step towards the formation of the external and internal 
alv T eolar plates. At this period the pulpy substance be- 
comes partially divided into two distinct portions, and 
corresponding filaments of bone are seen shooting across 
from one side to the other of the bony groove, to form the 
future transverse divisions of the alv r eoli. These pulps are 
the rudiments or basis upon which the teeth are formed. 
At this time they lie upon the vessels and nerves which run 
along the bottom of the groove ; they are very soft, gelati- 
nous and semi-transparent ; and each is partially enclosed 
in a membrane or sac. At the fourth month, if the sac be 
opened a small point of ossification is found to have been 
deposited upon certain of the pulps, and this is the com- 
mencement of the formation of the bony substances of the 
teeth." 

The analysis of the human tooth, according to Berzelius, 
in the enamel is in 100 parts. 



Phosphate of Lime, 


85.3 


Fluate of Lime, 


3.2 


Carbonate of Lime, 


8. 


Phosphate of Magnesia, 


1.5 


Soda and Muriate of Soda, 


1. 


Animal Matter and Water, 


1. 



100 



20 DENTAL SURGERY. 



In the bone is, 




Phosphate of Lime, 


- 62. 


Fluate of Lime , - 


2. 


Carbonate of Lime, 


- 5.5 


Phosphate of Magnesia, 


1. 


Soda and Muriate of Soda, 


- 1.5 


Gelatine and Water, - 


28. 



100 

The first sett of teeth are less dense than the succeeding 
ones. The enamel of the tooth is formed by secretions 
from its pulp, which are thrown out upon the cutting edges 
of the incisores and the points of the molar teeth, until it 
extends over the whole surface of the crow T n, depositing a 
thin crust of enamel ; the cavity of the pulp gradually fills 
up with bone in the formation of the tooth, leaving but a 
small orifice, extending through each fang to the centre of 
the body of the tooth ; this canal is supplied with nerves 
and blood vessels, that ramify through the bony structure 
of the tooth to its surface, affording it nourishment and 
sustenance. The enamel serves as a protection to the ner- 
vous sensibility of the tooth, to its confines, the edge of 
the alveolar. If by accident or decay, any portion of the 
enamel be removed, the internal and vascular part of the 
tooth will be found extremely sensitive, and so continues, 
until the sensibility is removed by exposure or the applica- 
tion of caustic agents; the same effect will ensue by a 
displacement of the gums, a circumstance often caused by 
depositions of tarter. 

Dr. Wesley, in his work on Natural Philosophy, says 



THE ANATOMY OF THE TEETH. 21 

that the teeth only, of all the bones, grow in length during 
a man's whole life. Dr. Wesley, though very learned in 
many features of animal mechanics, and philosophical facts, 
nevertheless has certainly committed an error in the ad- 
vancement of the above theory ; he has very probably been 
led into such a conclusion from the gradual displacement 
or elevation of a tooth upon the loss of its antagonist. 

Another writer, referring to the reproduction of os- 
seous matter in the animal system, says, it is very pleasing 
to observe the different means employed where a slight 
change of circumstance demands it. This earth of bone — 
the phosphate of lime — is changing continually, but the 
teeth admit of no change ; bodies calculated for such 
violent attrition, and with a surface so hard as to strike fire 
with steel, would be ill accommodated with such a pro- 
perty of changing as we find in the bones. They must, 
therefore, fall out and be succeeded by new ones, and this 
process, familiar as it may be, is very curious when 
philosophically considered. There are no teeth whilst yet 
the infant is at the breast ; and when they arise they are 
attended with new appetites and a necessity for change of 
food. When perfected they form a range of teeth, neat 
and small, adapted to the child's jaws and the size of its 
bones ; were they to grow at once, or to fall out at once, 
it would prove a disturbance to the act of eating. They 
fall in succession ; their fangs are absorbed ; they are loose 
and jangling, and are easily extracted. But now comes 
the question. Why are the teeth of the infant old at six 
years ? Why are those that are to succeed and be sta- 
tionary for a series of years, to germinate and grow at the 
3 



22 DENTAL SURGERY. 

appointed time, like the buds in the axilla of a leaf; and 
when fully formed, why do they remain perfect for sixty 
years finstead of six, at the end of which time the first 
were old and decayed. No difference can be observed in 
the material of the first or second set, the one will be as 
perfect as the other after remaining one hundred years in 
the charnel house. Can any one refuse his belief, then, 
when he sees so accurate a mechanical adaptation of the 
teeth to their places and offices. Can he, we say, refuse 
assent to this, also, that there is a law impressed, a property 
by which the milk-teeth shall fail and be discharged from 
the jaw in six years, whilst the others will last the natural 
life of the adult, if not injured by accident or decay, to 
which all parts are subject. 

The infant or first set are twenty in number. 
- The succeeding, or permanent set, when complete, are 
thirty-two in number, and are arranged in each jaw in the 
following order : 

Two large or central incisores. 

Two small or lateral incisores. 

Two cuspidati or eye teeth. 

Four bicuspidati. 

kix molares. 

The posterior molar, situated at the angle of each jaw, 
is commonly called the wisdom tooth, from its appearance 
at that age known as the period of discretion. 



CHAPTER II. 



FIRST DENTITION. 

The time of teething is with children the most dange- 
rous period of their lives ; the eruption of the first set is 
generally attended with great irritation and severe constitu- 
tional affection. 

The period of first dentition varies according to the 
health and vigor of the constitution. Children that are 
strong and healthy generally commence to cut their teeth 
at the fifth or. sixth month; occasional instances have been 
known of their appearance at the fourth month, and even 
at birth ; with those of a delicate frame the process is 
more tedious, and is sometimes delayed to the tenth or 
eleventh months ; the teeth continue to advance in pairs, 
at intervals, until the second or third year, by which time 
the deciduous dental arch is complete. No definite rule 
can be laid dow r n for the time and order of their approach, 
as it varies so much under different circumstances. The 
following may be regarded as a fair proportionate average : 
The Central Incisores, at seven months. 
" Lateral " at nine " 

" First Molares, at fourteen " 
" Cuspidati, at eighteen " 

" Second Molares, at thirty " 
The lower teeth precede the upper ones about two 



24 DENTAL SURGERY. 

months ; the reverse sometimes, though very seldom, 
occurs. The process of first dentition cannot be too care- 
fully guarded ; for from it, not unfrequently arises the origin 
of many diseases that are revealed later in life. 

The irritation that precedes the cutting of the deciduous 
teeth is occasioned by the pressure of the advancing tooth 
against the investing membrane, and is in accordance with 
the proportionate absorption of this membrane and the 
growth of the tooth. 

The approach of the teeth may be known by severe 
general symptoms ; the child becomes fretful and peevish ; 
the salivary glands secrete more freely ; drowsiness follows, 
attended with a moderate diarrhoea. These symptoms are 
the operations of nature in her efforts to counteract the 
more dangerous consequences, and as they are influenced 
by the teeth that have produced the irritation, subside upon 
the eruption of those teeth. 

It is, however, frequently the case, that the process of 
first dentition becomes more alarming and dangerous ; the 
disease assumes a constitutional character ; the fever in- 
creases, attended with an excessive diarrhoea, or, as it 
sometimes occurs, ceases entirely ; the breathing becomes 
more difficult, and the little sufferer writhes under severe 
pain ; spasms take plaee, succeeded by occasional fits, 
terminating, unless speedily relieved, with the patient's life. 

The treatment of these diseases should be constitutional 
and local, observing a proper regard in the condition of the 
bowels, and immersing the child in warm water, which, 
with other remedies on the surface of the skin, produce 
a counter termination of the blood from the brain. An 



FIRST DENTITION. 25 

immediate and the exciting cause should not be forgotten — 
the pressure upon the gum should be relieved. 

This operation has been the subject of much groundless 
opposition, but the objections are rapidly disappearing before 
the advancement and revelations of science, and it is now per- 
formed by almost every practical medical or dental surgeon. 

For a proper convenience and success in lancing the 
gums, the operator should possess a curved lance, with a 
broad, round point, made very sharp ; and with it, incise 
the gum, parallel with the edge of the approaching tooth, 
making also a transverse incision across the centre of the 
first, and pressing the lancet in the gum until it is felt 
against the hard substance of the tooth. 

Such is the relief often afforded by this operation, that I 
have known children who have suffered severely for 
several days, to immediately cease from crying as soon as 
the instrument had penetrated the gum, and seem rather to 
court than resist the operation. 

A very cruel practice of nurses and parents cannot be 
too much condemned, I refer to the frequent habit of rub- 
bing the gums with coral or their thimbles ; it not only 
inflicts useless and unnecessary pain, but may occasion 
more serious consequences. 

When the deciduous teeth have all made their appearance, 

and the jaws of the child are filled with their compliment, 

then another and responsible duty devolves upon the 

parent or guardian. As this set is designed for an especial 

and preparatory purpose, any thing operating prejudicially 

must be attended with future evil. 

A proper care should be exercised for the retention of 
3* 



26 DENTAL SURGERY. 

these teeth in health and cleanliness, until they are super- 
ceded by those which are to follow, the necessity for which 
may be explained by two reasons. First. As nature pro- 
vides, by absorption of the fangs of the deciduous teeth, 
their removal to give place to a succeeding set, so any 
thing acting contrary to that economy must be more or less 
liable to occasion derangement in their progression and 
character. Secondly. As many of the teeth of both sets 
exist in the mouth at the same time, and as contamination 
is a fruitful source of decay, another and very powerful 
evidence presents [itself of the necessity of health in the 
deciduous teeth. The use of a tooth-brush of a proper 
form and size becomes necessary at an early age, in order 
to remove the deposite that settles upon the teeth, in their 
indentations and interstices. 

This process must be performed by the parent until the 
child has learned the use and object of the brush ; it is 
sometimes necessary to employ dentrifice, of which care is 
necessary in the selection. An equal proportion of orris 
root and prepared chalk, finely pulverized, is all sufficient. 

When caries has taken place in the molar teeth, they 
should be filled, as it is very important that they be re- 
tained until thrown out by the process of absorption. The 
premature extraction of these teeth is likely to occasion 
bad results, and should only be resorted to when all palia- 
tive remedies fail. As this set of teeth is only designed 
for a temporary purpose, and the increased energies of the 
child require a different kind of aliment, they give place to, 
and are succeeded by a set larger and stronger, and better 
adapted to the purposes of the adult. 



SECOND DENTITION. 



SECOND DENTITION. 



The period of second dentition gives data to one of the 
important natural changes that take place in the life of 
man. 

As the child depends upon the maternal breast for susten- 
ance in the early stage of its existence, it needs no teeth, 
and as it advances in growth, its constitutional require- 
ments demand a more substantial nutriment ; then nature 
assists with the production of a set suited in size and 
number to its age. But as the child increases in strength 
and vigor, these teeth are found inadequate, and another 
set, in regular progression, gradually usurp their place. 
In order that the mouth may not be destitute at any time of 
a sufficient number of teeth, the anterior permanent molares 
advance through the gum before the moulting of the tem- 
porary ones. As these teeth emerge behind the posterior 
teeth of the first set, they have less resistance to over- 
come, and consequently do not require the necessary 
absorption of other teeth to enable them to occupy their 
position. 

The first molares of the permanent set are succeeded 
by the central incisores of the lower jaw, in from one to 
two years ; by this time, frequently the corresponding upper 
teeth have also advanced ; in another year the lateral in- 
cisores make their appearance ; the bicuspides follow next 
in about the same intermission of time ; then come the 
cuspidati or eye teeth, one year after the second bicuspides, 
and by the time the child has attained to the age of thir- 
teen or fourteen years, the second molares complete the 



28 DENTAL SURGERY. 

permanent set. The wisdom teeth are very uncertain in 
the time of their eruption, varying from nineteen to forty, 
or even fifty years. These teeth have been universally 
classed with the permanent set, but in their general 
characteristics resemble more the temporary teeth ; they are 
so called, the dentes sapiential, (or teeth of wisdom,) because 
of their appearance after the age of puberty, or at that 
time of life when man assumes a proper discretionary 
ability. 

Second dentition is not accompanied with the severe 
symptoms that attend the obtrusion of the first set, owing 
no doubt to the increased strength and vigor of the consti- 
tution, together with the fact that a passage is opened for 
them by the moulting of the temporary teeth. 

The means employed by nature in the growth of the 
second set, is concluded by an absorption of the fangs of 
the primary teeth, by which they fall out and give place to 
their more permanent successors. This order is not unfre- 
quently disturbed ; from some concealed or apparent 
cause the absorption is slow in comparison with the growth 
of the advancing tooth, and, in consequence, it is forced 
from its proper course, emerging upon the inside or outside 
of the temporary tooth. 

It is with the commencement of second dentition that 
the importance of professional supervision is necessary, for 
if a proper care is observed in the regularity of the per- 
manent teeth, many of the diseases to which they are 
liable might be avoided. 

The pressure of teeth crowded together soon destroys 



SECOND DENTITION. 29 

their vitality, and decay follows, which, if not speedily 
remedied, must eventually result in their loss. 

Many of the deformities of the face may be traced to 
neglect in the growth of the second denture. The eruption 
of the incisores of the lower jaw, before the absorption of 
the fangs of the temporaries, frequently occur on the outside 
of the remaining teeth, and lay the foundation for an entire 
overjutting of the lower jaw, by which the upper teeth 
close inside, contrary to the natural articulation. The same 
results follow from the advancement of the superior per- 
manent incisores inside of, and before the loss of their tem- 
porary antecedents. This malformation has frequently been 
supposed to be caused by an elongation of the lower jaw, 
when, in reality, it is almost solely attributable to neglect in 
dentition. 

In order to assist in the regularity and order of the 
second teeth, the mouth should be examined frequently for 
the purpose ; if a tooth is found emerging through the 
gum, opposed by a contiguous temporary one, the opposing 
tooth should be at once removed ; if any doubt exists as to 
the tooth to be extracted, the one posteriorly situated is 
to be preferred. 

The dentist should not be too hasty in the extraction of 
a deciduous tooth ; if done prematurely, it endangers injury 
to the pulp of the advancing tooth, and may operate 
against its completion and final obtrusion ; to which cause, 
doubtless, may be referred, in many cases, the want of cer- 
tain teeth belonging to the second denture. 

It seldom becomes necessary to extract a temporary 
tooth before its alternate has made some show of eruption^ 



30 DENTAL SURGERY. 

unless effected with caries, and insupportably painful to the 
patient ; even then it were advisable to soothe the pain, if 
possible, without extracting the tooth ; in fact, this should 
only be a last • resource. The pain may generally be 
allayed by the application of laudanum, a preparation of 
equal parts of camphor and opium, or kreosote. 

Liquids should be dropped on cotton or lint, and, when 
placed in a cavity, covered with soft beeswax, to prevent 
it from mingling with the saliva. 

If all remedies fail, and the tooth continues to ache, then 
it becomes necessary to extract it, which should be done 
with every possible care, to avoid injury to the approach- 
ing permanent tooth. 

Parents generally entertain a misconceived opinion of 
the necessity of extracting a deciduous tooth, " because it 
is loose," and at the same time deny the propriety of ex- 
tracting one more firm, that probably offers all the resist- 
ance, thus urging nature in her successful efforts, and re- 
fusing assistance when most needed. 

The inferior central incisores are liable, in their protru- 
sion, to be forced inside or outside of the primitive teeth, 
and as they are larger than those teeth, generally require 
the extraction of the laterals, as well as centrals, to give 
them sufficient room ; though a probable change may be 
made to correct a subsequent irregularity, it is highly im- 
portant that it be done as early as the facts may appear to 
demand. Mr. Bell and Mons. Delabarre both recommend 
the application of a file to give space for teeth that are 
crowded, of which Dr. Harris says, "Notwithstanding the 
deservedly high authority of these two gentlemen, my own 



SECOND DENTITION. 31 

experience compels me to reject the pratice." The objec- 
tions given by Dr. H. are to some degree applicable, 
but in my opinion do not constitute the only ground of 
objection. 

In order to obtain the necessary amount of space, i. e. 
half the amount of a tooth, it requires so much to be taken 
from the enamel of the tooth as to expose the bony sub- 
stance, and, in cases that have been presented to me, I 
have found a total necrosis of the tooth, that could only be 
referred to inflammation produced in filing it excessively, 
soon after its passage through the gums, done for the above 
purpose by followers of Mr. Bell's theory. 

The superior central incisores are much larger than the 
same temporary teeth, and often require the extraction of 
the lateral to give them a sufficiency of room. 

The cuspidati are the most liable to derangement, they 
being the last to appear, excepting the posterior molares ; 
oftentimes the whole circle is filled by the permanent teeth, 
which have already protruded, and the cuspidati find egress 
only through the upper parts of the gum, on either side of 
the dental circle ; when this occurs the second bicuspide 
should be immediately removed ; in fact it should be per- 
formed in anticipation of the arrival of the cuspidati, if 
circumstances warrant it ; the anterior bicuspide will soon 
fall into the place of the one extracted, and the cuspidati 
will assume its proper place. 

I cannot conclude this subject without recommending 
especial attention to the health, as well as the beauty of 
the arrangement of the permanent teeth. It is frequently 
the case, that the first molares decay in a few months after 



32 DENTAL SURGERY. 

their eruption, and as they follow the deciduous teeth so 
soon, parents are deceived, believing them to belong to 
the first set, consequently they remain indifferent to the 
preservation of them. 

The dentist should, on every occasion, when consulted 
in reference to the dentition of children, explain the cha- 
racter of the different teeth, and the mode of treatment to 
be pursued ; the use of a tooth-brush should be urgently 
recommended, and any decay that may insiduously enter 
upon the teeth, remedied or removed at once ; for which 
the operator will enjoy the satisfaction and reputation of 
having been the means of securing a sound and well- 
arranged set of teeth. 



THIRD DENTITION. 

Instances of a third set of teeth are of rare occurrence, 
though sufficiently well-attested evidences of their existence 
have been recorded, — placing the fact beyond cavil or 
doubt. 

They generally appear at a very advanced age, and 
usually precede a material change of the constitution. For 
a short time the system seems endowed with recuperative 
powers, and regains a youthful vigor and energy ; but 
nature speedily relapses, and death soon follows. 

Mr. Bell doubts the reality of a third set as of new for- 
mation, but regards them rather as " the retarded comple- 



THIRD DENTITION. 33 

tion of certain of the second set,;" at the same time Mr. B. 
admits the frequent occurrence of what he calls " supernu- 
merary teeth," which, appearing with the second set of 
teeth, entitle them to that appellative, the origin of which 
he thus describes. " It not unfrequently happens that the 
pulp of a temporary tooth, in addition to the rudiment of 
the permanent one naturally destined to succeed it, gives 
off, also, a second process, which produces a supernumerary 
tooth." That a third set, or any number of supernumerary 
teeth, may be formed by the same process, and prevented 
from eruption by the existing teeth, does not seem to me 
improbable, though I incline to the opinion that other 
causes exist in their formation. The following appears in 
evidence, and is a well-authenticated fact. Extract of a 
letter dated at Venice. " The renewal complete of all her 
teeth, in the mouth of a woman ninety years old. She is 
the sister Theodosia of the Carmelite Convent in that city. 
What makes the case still more remarkable is, that the 
same nun renewed all her teeth at the age of forty-seven, 
and again at sixty-three. She has grown a complete set of 
teeth five separate times during her life." 

That a second set of teeth should be formed from the 
pulp of the primitive ones seems plausible enough, but 
that four other sets should be produced from the same cause 
admits of much improbability. 

Dr. Good, in his study of medicine, mentions a case 

related by Dr. Besset, of Kuayton, in which the patient, a 

female in her ninety-eighth year, cut twelve molar teeth, 

mostly in the lower jaw, four of which were thrown out 

soon afterwards, while the rest, at the time of examination, 
4 



34 DENTAL SURGERY. 

were found more or less loose." Dr. Hunter relates a case 
in which he witnessed the reproduction of a complete set 
in both jaws, apparently with a renewal of their sockets. 

Antiquity, as well as modern history, furnishes many in- 
stances of more than two sets, and all agree in the advanced 
time of life of their appearance, and the physical changes 
that attend their growth. 

Dr. Harris relates two cases of parts of sets that he 
witnessed himself, as also one mentioned by a friend of 
his, Dr. McCabe, of Virginia, of which he says : " He, 
' the patient' is now in his seventy-eighth year, and, as he 
playfully remarked, 'is just cutting his teeth.' There are 
eleven out, five in the upper and six in the low r er jaw. 
Those in the upper jaw are two central incisores, one 
lateral and two bicuspides, on the right side. Those in 
the lower, are four incisores, one cuspidatus, and one 
molaris. Their appearance is that of bone, extremely 
rough, without any coating of enamel, and of a dingy 
brown color." 

A case, of a gentleman living in Cape May county, 
New Jersey, was related to me by a friend, in whose 
veracity and judgment I have the most implicit confidence ; 
the said individual renewed a set of teeth at the age of 
ninety, complete in both jaws. 

I have never seen an example of entire sets in third 
dentition, but have known several cases of supernumerary 
teeth, one of which I found situated contiguously with the 
dens sapientiffi of the left side of the upper jaw T . 



IRREGULARITY OF THE TEETH. 35 

IRREGULARITY OF THE TEETH. 

It is seldom that any disorder exists in the arrangement 
of the primary teeth, nor is it a very important matter, as 
the early loss of these teeth, by natural causes, must take 
place before the evils of crowded teeth would be felt. 

The free, unobstructed state of the gums, prior to first 
dentition, offers no obstacle to the progress of the infant 
teeth, and they, consequently, emerge in a regular and sym- 
metrical manner, while the second set, operated upon by 
different causes, are very frequently forced into a crowded 
and irregular group, a condition prejudicial to their appear- 
ance and health. 

The irregularities of the permanent teeth may be gene- 
rally attributable to two principal causes — the premature 
extraction of a deciduous tooth, by which an absorption of 
the parts take place, and the adjoining teeth are brought in 
contact, to the exclusion of a succeeding tooth ; and the 
protrusion of a permanent tooth, before the absorption of the 
deciduous fang. 

The evil consequences of crowded or irregular teeth 
are so apparent to every one, as to demand every necessary 
care in the avoidance of it. There is no feature of the 
face more conspicuous than the mouth, upon the beauty and 
symmetrical form of which depends its grace and elegance. 
A very frequent deformity of the lower jaw, a projection 
occasioned by the lower teeth closing outside of the upper 
ones, is mainly attributable to neglect in second dentition ; 
generally it is supposed to be caused by a natural elonga- 



36 DENTAL SURGERY. 

tion of the jaw, which is almost always an error, as the 
first is the principal and most frequent cause. 

The teeth most liable to derangement in their order, are 
the incisores and cuspidati of both jaws. 

The central incisores sometimes present an acute angle, 
with their contiguous sides turned outwards, in other cases 
the reverse occurs. 

The laterals being preceded by the central, from an 
insufficiency of room, frequently occupy a diagonal position, 
either overlapping the central teeth, or having their inner 
surfaces resting upon the sides of those teeth. 

The upper cuspidati often protrude above the crowns of 
the adjoining teeth ; either upon the outside, by which 
they become a serious inconvenience in causing a promi- 
nence of the lip ; or upon the inside, proving an obstacle 
to the tongue in its articulation 

The bicuspides of the same jaw are also subject to this 
derangement, but less frequently, as they appear before the 
cuspidati, and follow in the bifurcation of the fangs of 
the temporary molars ; when it does happen, it occasions a 
greater inconvenience than a similar irregularity of the 
cuspidati. 

The cuspidati and bicuspides of the lower jaw are fre- 
quently crowded outside of the dental circle, producing 
results similar to a like deformity of the corresponding 
teeth in the upper jaw. 

The upper teeth are sometimes found to incline with 
their cutting edges to the inside of the mouth, the opposite 
teeth closing outside of them. As this generally appears 
to be a natural disposition, it is more difficult of correction 



IRREGULARITY OF THE TEETH. 37 

than any other kind of disorganization, and should be 
treated, with any hope of success, in the early progression 
of those teeth. 

The cuspidati are sometimes found entirely excluded 
from the dental circle, and situated behind the other teeth, 
so that upon the occlusion of the jaws, they are altogether 
concealed from view. 

Another species of irregularity, by which the dental arch 
becomes contracted at the medial line, giving to the 
mouth a pointed appearance, is often the result of a pre- 
mature extraction of certain of the temporary teeth, pro- 
ducing an undue absorption before the advancement of the 
permanent ones; thus confining them to a less space than 
they should occupy, and crowding them into an elliptical 
form instead of the regular circle. 

The varieties of irregularity are numerous, but as those 
already stated constitute the most frequent characters, it 
w T ill be unnecessary to recapitulate cases that have been 
recorded by other writers, the certainty of which is per- 
petuated only by records of a single instance in their 
experience. 

To avoid the evils of crowded and irregular teeth, a 
proper care should be exercised in maintaining the health 
of the primary set, to keep them from decay and the neces- 
sity of extraction, before the proper time for their moulting 
and succession of the permanent teeth. 

The mouth should continue to be examined, during the 
whole course of second dentition, at frequent intervals, and 
the peculiar characteristics explained to the child's parent 

4* 



38 DENTAL SURGERY. 

or guardian, that they may be able to guard against the 
causes that operate in producing irregularity. 

Professional supervision should not stop even at the 
completion of the permanent set ; a little subsequent care 
may conduce to preserve the teeth in health and beauty to 
an advanced age. 



TREATMENT OF IRREGULARITY. 

The teeth may be altered in their relative position to 
each other by a proper course of treatment. Any required 
change should be made before the patient exceeds fourteen 
or fifteen years of age ; after that time the probabilities are 
against success, though not without hope. I have, suc- 
ceeded in correcting a very prominent deformity in the 
teeth of individuals several years older. 

If the dental surgeon is consulted before the entire com- 
pletion of the second denture, and any of the deciduous 
teeth remain in opposition to a regularity in the advance- 
ment of teeth belonging to the second set, he should at 
once extract the opposing tooth. It is frequently neces- 
sary to remove more than one — the permanent tooth being 
larger than the temporary one requires more room. In 
every case where the extraction of a second tooth is con- 
sidered necessary, the one posteriorly situated should be 
preferred, as it gives an opportunity for the teeth to spread, 
and a consequent enlargement of the dental circle. If, as 



TREATMENT OF IRREGULARITY. 39 

is frequently the case, the whole course of dentition has 
been allowed to proceed unassisted, and the teeth, instead 
of presenting a systematic arch, appear in a confused 
mass, he must then use mechanical means to remedy the 
neglect. 

If the upper teeth, or a portion of them, strike inside of 
the lower ones on the occlusion of the jaws, it may, when 
only partially so, be overcome by directing the patient to 
use a piece of ivory, flat on both sides, and held by one end, 
with the other resting upon the anterior side of the lower 
and posterior side of the upper teeth, and closing the jaws 
whilst held in that position ; but as it is difficult to ensure 
a constant practice of it, a more certain and convenient 
recourse should be had. 

I have, with universal success, substituted a metallic 
regulator acting upon the same principle. By obtaining a 
cast of the mouth, a plate is made to fit the posterior side 
of the teeth, with the end clasping a molar on each side ; 
upon the clasp a cap is soldered to fit the teeth on their 
grinding surfaces, which, meeting those of the opposite 
jaw, prevent their entire occlusion. Another piece is also 
soldered to it, to cover the cutting edges of the teeth that 
are to be corrected, and inclining in a position the same as 
would be given by the ivory. A very short time will 
suffice to change the relative position of the teeth. After 
they alter enough to allow them to close naturally, the regu- 
lator may be removed, the power of the jaw being suffi- 
cient to force the teeth into their proper place, when once 
they have received the necessary inclination. 



40 DENTAL SURGLRY. 

When the front incisores are situated with their central 
edges turned out, it is generally occasioned by a contraction 
of the jaw, and an insufficient amount of room for the 
necessary number of teeth ; the only remedy is to extract 
the first bicuspide of each side ; the other teeth will gradu- 
ally fall back, until the spaces occupied by the teeth that 
have been removed are filled up ; and the irregular incisores 
will regain their proper situation. 

It has been a common practice, when the lateral incisores 
are crowded out, to extract them ; thus bringing the cuspi- 
dati forward to occupy their places, though in a line with 
the front teeth ; the error of this practice would appear 
evident to any one, could they see the result. The same 
mode of treatment suggested to correct a prominence of the 
centrals should be resorted to in this case. 

A protrusion of the eye teeth above the crowns of the 
adjoining ones, may be remedied by the extraction of the 
second bicuspide ; if the first one be decayed or deranged 
in its position, or from any other sufficient cause, it may be 
preferred to the second ; but in the absence of a particular 
motive a choice should be given to the drawing of the 
second bicuspide. 

When these teeth are thrown entirely from the dental 
circle and are shut from sight upon the closing of the jaws, 
but little prospect can appear of bringing them out to their 
proper place. The operator must judge, from the circum- 
stances of the case, the practicability of extracting a bicus- 
pide, and by the aid of ligatures to the adjoining teeth 
forcing the tooth into the circle, or an extraction of the 



TREATMENT OF IBREGTJLARITY. 41 

errant member ; if the first expedient is adopted, it will be 
necessary to obviate the pressure of the opposite teeth as 
already recommended. 

To correct an unnatural occlusion of the front teeth, is 
the most difficult of all defects to remedy. The only way 
by which I have ever been able to effect an alteration has 
been by resisting the pressure of the jaws and preventing 
the teeth from coming in contact ; and by removing the 
lateral bearing of one tooth against another : the first is to be 
accomplished by inserting caps upon a molar tooth of each 
side, stamped between a die and lead, to make them fit 
accurately. The second by extracting a bicuspide from 
each side; after which, by a constant pressure exerted upon 
the posterior edge of the front teeth, they maybe ultimately 
forced out, until they close outside of the lower teeth ; an 
apparatus such as is described at page 39, modified to suit 
the peculiarities of the case, might be used to advantage. 

Of the many practices suggested for the correction of 
irregularity, that recommended by Mr. Bell, of filing the 
teeth to obtain space, is the most to be deprecated. 
Ligatures are also objectionable, as the silk or thread 
used is liable to force its way upon the neck of the tooth 
and under the gum, producing inflammation and injury to 
the parts. 



CHAPTER III. 



CARIES OF THE TEETH. 

This is a disease of no small importance, as by it, those 
useful conservators to our health, happiness and comfort, 
are almost universally destroyed ; all the teeth are subject 
to it, the primary as well as the second set, and both claim 
a merited degree of care and professional skill to save them 
from its destructive influence. The character of caries is 
the same in any of the teeth affected by it; in some cases, 
however, it is more rapid than others ; the tooth in the 
mouth of one person may be infected with caries, and with- 
out any sensible increase will remain so for years, while 
with another, in a very short time after it is first discovered, 
the disease extends rapidly through the body of the tooth, 
until it is irrecoverably consumed. 

A considerable difference exists in the liability of the 
teeth of different persons to be affected by this disease, 
influenced by attending circumstances with each. 

Teeth that are uniform and firm, surrounded by a healthy 
gum, and kept in a proper state of cleanliness are not liable 
to caries, while those in the mouth of a person whose con- 
stitution is shattered by disease, and whose gums are swol- 
len and turgid, and bearing all the characteristics of disease, 

are constantly liable to it, or even those who exert every 
42 



CARIES OF THE TEETH. 43 

necessary care in keeping their teeth clean, but have them 
in a crowded and confused disorder, cannot avoid, the 
insiduous operations of caries. A peculiar coincidence in 
the attacks of decay, by which corresponding teeth are 
known to be frequently affected at or near the same time, 
has been attributed, by some waiters, to a physical debility 
operating during the time of their formation, either pro- 
duced by a general constitutional disorder or from the 
effects of mercury. 

That an unhealthy state of the constitution existing at 
that time may contribute to render the teeth imperfect, 
admits of much doubt, inasmuch as the disease originating, 
according to that theory, in their very formation, would 
more probably continue immediately after their eruption ; 
whereas we often find disease so situated, delayed for 
twenty or even thirty years after the perfection and final 
passage through the gums of those teeth. 

A fact, that the teeth decay by pairs, may most gene- 
rally be traced to a like peculiarity in the order of their 
arrangement and corresponding situation with adjoining 
teeth, for w 7 hen such was not the case I have found the rule 
variable. 

Caries is not confined to particular teeth, but all are alike 
subject to it. The incisores and cuspidati are generally 
affected upon their sides and anterior and posterior sur- 
faces ; the bicuspides upon their sides, and the molars 
on their sides, in the indentations of their cutting edges, 
and upon the front surfaces. 

Decay first presents itself in the form of a speck or dark 



44 DENTAL SUKGERY. 

spot upon the external covering of the bone of the tooth, 
and progressing into the bony structure, unless arrested by 
proper remedies, continues until it reaches the dental canal. 

Upon the first exposure of the bone, an acute soreness is 
experienced, by taking water into the mouth, or inhaling the 
air over the affected tooth ; this feeling subsides in a few 
weeks, owing to the death of the fibrous nerves that have 
been exposed, and the tooth remains free from sensibility 
until the decay has extended to the lining membrane, 
which becomes evident by the violent throbbing pain felt 
in the diseased tooth. At this stage of decay no permanent 
relief can be guarantied ; if caustic preparations are applied 
to deaden the sensibility of the nerve, inflammation is likely 
to supervene with all its accompanying evils, and the only 
remedy that remains is a removal of the tooth. 

Some controversy has taken place relative to the applica- 
tion of -the word " Caries," whether it correctly defines this 
peculiar disease of the teeth. Mr. Bell introduces the term 
"gangrene" as he supposes more explicit of the character 
of the disease known as decay. 

Gangrene, from Gangraana, was admitted into the Latin 
clavis, derived from the Greek noun yaytpcs — (Gagilos) ; 
signifying a cancer, or eating of the flesh, and so autho- 
rised by Celsus, who used it only to express an ulcer or 
mortification of the flesh ; it consequently cannot properly 
belong to diseases of the bones. 

Mortification is also applied to this affection of the teeth ; 
it is not strictly applicable, as a tooth may be, to some 
extent, decayed, and so remain for years without the death 



CARIES OF THE TEETH. 45 

of the organ. Messrs. Fox & Hunter both use this expres- 
sion as significant of decay in the teeth. 

Caries is literally from the Latin, expressive of rotten- 
ness or decay, and therefore more properly defines that 
disease of the teeth. 

Instances of the bad effects arising from decayed teeth, 
are of frequent occurrence, and oftentimes the dental sur- 
geon is consulted in extreme cases, when not only the 
health and comfort of the patient is at stake, but the life 
itself endangered. Many remarkable cases have happened 
in the course of my practice. One was that of Mrs. K. 
of Salem. After filling several teeth for her, and perform- 
ing other operations on her teeth, I advised the removal of 
a tooth, which bore all the characteristics of inflammation ; 
she however declined, in opposition to every remon- 
strance. A few days subsequently I was sent for, and 
found her suffering all the agonies of a complicated decay, 
in the tooth aforementioned. Her face was swollen, and 
one eye entirely closed, and it was with difficulty that even 
a knife blade could be forced between her teeth. After 
directing the proper remedies I left her ; in the course of 
twenty-four hours, the suppuration gathered to a point and 
broke; but the inflammation, having extended to the 
throat, caused her to suffer for several weeks with a malig- 
nant disease of that part. The same lady again endured 
almost as much as on the first occasion, but so great was 
her dread of having a tooth extracted, that she retains that 
tooth in her mouth to this day. Another case, though not 
so serious in its consequences, was that of Mr. P. of 
5 



46 DENTAL SURGERY. 

Woodstown. The second inferior bicuspidati gave him 
considerable pain, and he applied to a neighboring physi- 
cian to extract it, who, unfortunately, broke off the crown, 
leaving the fang in the jaw ; violent inflammation took 
place, and suppuration followed ; it finally broke on the 
outside of the jaw, and continued to discharge for more 
than a year, when he applied to me to remove the fang. 
After its extraction the wound soon healed, but left a 
scar to mark the spot. 

Diseases of the above character are not confined exclu- 
sively to the adult teeth ; children often suffer from aggra- 
vated cases of complicated decay ; and as the consequences 
are sometimes fatal to the second growth, the cause should 
be removed without delay. 



CAUSE OF CARIES. 

Caries has been regarded as arising from constitutional 
causes by some writers, while others maintain it to be the 
effect alone of local agents. 

There can be no doubt that a diseased state of the sys- 
tem is a remote cause of decay very frequently, and that a 
hereditary predisposition to caries in the teeth, exists to a 
certain extent in some families. 

I have seen the same character of disease from the elder 
to the younger branches of a family, and have found them, 
to lose by decay, corresponding teeth at the same ages. 



CAUSE OF CARIES. 47 

Individuals of a delicate constitution, or laboring under 
continued disease, particularly of the digestive organs, are 
subject to bad teeth ; in the former, partaking of the general 
debility, and in the latter, by its effect upon the salivary 
secretions. 

Constitutional predisposition cannot be regarded as a 
universal'cause of decay. A tooth, from some remote con- 
stitutional effect, may be more susceptible of caries than 
one less apparently healthy, and the immediate existence 
of an active solvent would sooner operate upon that tooth 
than another : but without the agency of a local cause, 
the tooth would probably have withstood for a longer time, 
the effects of ordinary use and exposure. 

Inoculation is frequently produced from a diseased crown 
or fang lying contiguous with a sound tooth, by sustaining 
the calculus convenient for its operation, or by the attrition 
of its rough jagged points. 

Crowding of the teeth is another ultimate cause of caries. 
We find teeth, particularly the superior incisores, sound in 
every other respect, and presenting all the appearances, 
externally, of strong, healthy teeth, but lying in immediate 
contact, to decay upon their contiguous sides. *There is 
doubtless an attrition between teeth pressing against each 
other, aided by the salivary secretions that are deposited 
between them, that produces, to some extent, a denudation 
of the enamel, and consequently renders the surface rough, 
and more capable of retaining an active agent in their 

* Since writing the above I have found the same idea advanced by 
Mr. Waite, in his « Treatise on the Gums." I was not aware that such 
an opinion was entertained by any one but myself. 



48 DENTAL SURGERY. 

decomposition. Some teeth are more susceptible of decay 
than others ; those of a pearly whiteness seem the most pre- 
disposed, while teeth of a yellowish cast are generally the 
longest lived. The wisdom teeth are often found decayed 
by the time the tooth is fully developed, and in fact they 
seldom remain sound for any length of time. The inferior 
incisores and cuspidati are more permanent, and less subject 
to decay than any other teeth in the human mouth ; which 
may be attributed to the greater proportion of enamel to 
the bone in those teeth, and their situation relative to the 
salivary glands. 

Acrid food, or acidulous fluids, hold a decomposing in- 
fluence upon the teeth, which is evident from the fact, that 
hogs fed upon apples during the summer season, have their 
teeth so much destroyed as to be unable, when the time 
arrives for fattening them, to properly masticate their 
corn. Some farmers forbear feeding them on fruit for 
this reason. 

Fractures of the teeth are immediate causes of decay ; 
by exposing the bony structure, the tooth is deprived of its 
natural covering, and soon falls a victim to corrosive 
agents. 

Unskilful dental operations are frequent inciting causes 
of caries; by leaving a filed surface, rough and uneven, 
lodgments are afforded for depositions of tartar ; and also 
by scaling the teeth with sharp pointed instruments. An 
evidence was presented to me recently. A Mr. C. whose 
teeth were remarkably good, was induced by an itinerant 
operator to allow him to practice on them, or in other 
words, " to clean them." In doing so he ploughed the 



CAUSE OF CARIES. 49 

whole external surfaces into deep acute furrows, which 
soon filled up with depositions of tartar, and at this time, 
a lapse of two years, his teeth present an exterior of de- 
cayed lines upon the whole surface. 

The sympathetic relation of the gums and teeth, with- 
out doubt, produce by disease in the one a corresponding 
influence upon the other, and hence a necessity for a con- 
tinual regard to the health of the gums to maintain a 
healthy condition in the teeth. I have long been impressed 
with a belief, that inflammation in the gums leads to the 
production of a matter, which being deposited in the in- 
dentations and interstices of the teeth, speedily occasions 
a decomposition of them, and consequent loss by caries. 
Mr. Waite says : " If a question were asked as to what 
most influenced the loss of teeth, it could not be denied 
that it is the sympathy between the gums and the constitu- 
tion. If a second question were put as to the immediate 
influence the gums transmit to the teeth, the answer would 
be that they send their influence to them in a two-fold 
degree. 

1st. The morbid exhalations and exudations from 
diseased gums decompose the structure of the enamel, and, 
by decaying the teeth, exert a primary influence over 
them. 

2d. Regarding their loss through looseness, the sym- 
pathy between the gums and the constitution is greatly 
concerned ; for when the former become inflamed the 
periosteum is also in the same state. There are also many 
other considerations of great importance to the gums. 

A properly regulated diet, adapted to the exigencies of the 
5* 



50 DENTAL SURGERY. 

constitution, and according to the strength and fatigue the 
system is capable of enduring. We see the gums of a 
bon vivant swollen and unhealthy ; and when the system 
is below par we also see them unhealthy and irritable. 

From observations I have made in my intercourse with 
various classes of society, I would give the former gum to 
luxurious citizens, and the latter to the refined branches of 
our female aristocracy. 

In all diseases of the teeth, whether resulting from con- 
stitutional disturbance or from the effects of external appli- 
cation, the gums are in a certain measure affected. If, at 
the onset, when a decay is incipient in a tooth, there should 
not appear any degree of irritation in the gums, still, the 
moment the nerve is affected, irritation is known to super- 
vene. 

On the teeth, themselves, diseased gums exert a primary 
influence throughout all the variations of life ; the child 
and the adult, the middle-aged and the old person ; each 
possessing these organs in a bad state, if the gums be 
unsound and impure. 

The accumulation of a viscid secretion, commonly called 
tartar, is a powerful agent in the destruction of the teeth 
and alveoli. 



. TARTAR. 

This substance is a deposite of salivary calculus upon 
the enamel of the teeth, and is of two kinds. That which 
accumulates upon the molares, and the inside of the lower 



TARTAR. 



51 



incisores, is generally of a dark yellow or brown color, and 
collects to a mass, sometimes greater than the size of the 
teeth. Frequently it settles upon the alveolar ridges, and, 
insinuating itself under the gum, destroys the periosteum, 
causes the absorption of the alveolar, and finally the loss 
of the tooth. 

The other is of a green appearance, and a softer con- 
sistence than the first, presenting more the character of a 
stain; it is most frequent on the teeth of children, and 
more likely to produce caries than the harder kind. 
Various theories have presented the origin and nature of 
this destructive agent in different views. 

One writer has discovered the existence of a set of 
minute glands in the gums, destined to subserve the pur- 
pose of secreting tartar only. Another says, u that this 
substance is neither deposited by the saliva, nor secreted 
by any glands proper to that office; but that it is produced 
by the mucous follicles of the mouth ;" and to support his 
argument, he contends that all other calculous concretions 
are produced by a similar action either of the mucous or 
synovial membranes. 

Mr. Bell asserts, that it is a deposite from the saliva, 
from the fact that it is found in greater quantities opposite 
the openings of the salivary glands ; and upon analysis, is 
ascertained to contain the same ingredients, of which the 
saliva is composed. 

Tartar, I think, may be attributed to various sources, of 
which the saliva is the vehicle by which it is conducted, 
without possessing any of the principles of its formation. 
The exudation from diseased gums, doubtless contributes 



52 DENTAL SURGERY. 

freely to its accumulation ; a peculiar character of secretion 
of the mucous membrane during an unhealthy condition of 
the stomach ; the agglutinous nature of the food and many 
fluids taken in the mouth ; and the use of mercury, 
tobacco, and dentifrices made with sugar and honey, are 
all active causes of it. 

M. Mandl, in a paper read before the Paris Institute, enti- 
tled " Microscopic Investigations as to the Nature of the 
Tartar and Mucous Covering of the Tongue and Teeth,'' 
says, " the human mouth is a perfect cemetry, where 
millions of infusoria find their catacombs." 

Leuwenhoeck also says, " that the human mouth is 
peopled with infusory animals, and that the mucous 
secretion on its surface served as the medium in which they 
exist." But it remained for M. Mandl to discover that the 
tartar which covers the teeth is formed of the mountains of 
the dead of this medium. 

I question very much the correctness of such conclu- 
sions. The tartar, when taken from the mouth, is of a 
putrid character, and as likely to generate infusoria, after 
that, as that it should exist while in the mouth, even 
though but a moment of time elapse. 

Certain diets are supposed to contribute more than others 
to the formation of tartar. By some it is believed that 
animal matter is productive of stronger viscid secretions 
than vegetable. 

The inhabitants of the Isle of Maderia are remarkable 
for the soundness of their teeth, their food being principally 
vegetable, eaten in a raw state. 

The natives of the slave coast of South America possess 



THE EFFECT OF TOBACCO UPON THE TEETH. 53 

the same characteristic, and their food is chiefly vegetable 
also. But we are told that some tribes who depend more 
on animal food are equally favored in the health cf their 
teeth. Such a contrariety of evidence deprives us of any 
reasonable conclusions as to the effect of particular kinds 
of food. 

Fluids drank too hot or too cold, are liable to induce 
inflammation in the teeth, which renders them more sus- 
ceptible of disease, 



THE EFFECT OF TOBACCO UPON THE TEETH, 

The dentist is frequently consulted concerning the 
effects of tobacco upon the teeth ; whether it exercises an 
injurious tendency or is beneficial to them. Were it not 
for the universal habit of chewing and smoking, no apology 
would be sufficient for such a question, as the visible 
effects must be evident to every one, who will impartially 
examine for themselves. 

Some writers, and a few eminent practitioners, have 
encouraged and recommended its use, denying that it was 
productive of injury, and accepting a few isolated cases, 
have based their decision upon such, without sufficiently 
investigating the real nature and effect of its operations. 
That it is injurious, may be inferred from two circumstances. 
First, the action upon the gums, and thence indirectly upon 
the vital functions of the tooth ; and, secondly, by absorp- 



54 DENTAL SURGERY. 

tion of its active properties into the bony substance of the 
tooth. Individuals long accustomed to the use of tobacco 
are very apt to have turgid and swollen gums, and the 
sympathetic action between the teeth and gums soon pro- 
duces a morbid condition in the former, by which they are 
the more predisposed to disease. The teeth, not only 
externally, but upon an anatomical examination, will be 
found highly impregnated with a yellow fluid, evident only 
in the teeth of persons who use tobacco. 

An argument, very general in extenuation of the use of 
tobacco, is the influence supposed to be exerted by it upon 
an aching tooth. There can be no doubt, when the pain 
arises from inflammation of the investing membrane, that 
the narcotic properties of tobacco will for a time give 
relief, but the effect w T ill also subside by a continuation of 
its use. 

The use of tobacco is a national peculiarity, and belongs 
more particularly to the people of the United States than 
any other part of the world ; it is with us as opium to the 
Chinese ; differing only in the objects of its use. We use 
tobacco as an employment ; (for no other actual purpose 
can be attributed to it ;) they opium, for its narcotizing 
effects. The one is as reprehensible as the other ; either 
must produce consequences, fatal or injurious, according to 
the extent of its use. 

Independent of the effects of tobacco on the teeth, the 
baneful influence exercised by it upon the physical organi- 
zation should alone discard it for ever from common use. 

Few persons can long indulge in the use of it, without 
they experience an almost continued sensation of sickness 



THE EFFECT OF TOBACCO UPON THE TEETH. 55 

and vertigo, debility, loss of appetite, and nervousness, 
which must rapidly destroy the constitution and lay the 
foundation of fatal disease. Other accomplishments may 
be studied, without half of the repugnance felt in striving 
to acquire a fondness for tobacco, more creditable, and 
beneficial to the health and general comfort. Dr. Wood- 
ward, speaking of tobacco, says: — 

" The use of tobacco, in whatever form, is injurious to 
health, incompatible with cleanliness, and offensive to 
decency. It is equally repulsive to the outward senses, 
and disgusting to the inward tastes." 
. Dr. Rush says : " It impairs appetite, produces dys- 
pepsia, tremors, vertigo, headache, and epilepsy. It 
injures the voice, destroys the teeth, and imparts to the 
complexion a disagreeable dusky brown." 

Dr. Boerhave says, that, " Since the use of tobacco has 
been so general in Europe, the number of hypochondriacal 
and consumptive complaints has been increased, by its 
use." 

Dr. Cullen says : "I have known a small quantity, 
snuffed up the nose, to produce giddiness, stupor, and 
vomiting. There are many instances of its more violent 
effects, even of its proving a mortal poison." 

Dr. Darwin says: " It produces disease of the salivary 
glands and the pancreas, and injures the power of diges- 
tion, by occasioning the person to spit off the saliva which 
he ought to swallow." 

A volume of matter might be compiled, from the highest 
authorities, to prove the injurious effects of tobacco. It is 
not our purpose, here, to enter into a disquisition of its 



56 DENTAL SURGERY. 

constitutional effects, further than to refer to any unhealthy 
influence exercised upon the teeth by it, which must 
be a natural result of disorganization of the general 
system. 



THE EFFECTS OF MERCURY ON THE TEETH. 

This mineral, when given in quantities sufficient to 
produce ptyalism, exercises a deleterious action indirectly 
upon the teeth. As we have already endeavored to show 
that a diseased condition of the gums lead to a correspond- 
ing effect upon the teeth, so we might trace the operations 
of mercury, as evinced by the irritation it excites in the 
mouths of persons who have been long subjected to a 
course of treatment under it, to its ultimate effect upon the 
teeth. The free use of mercury produces an increased 
glandular action and vascularity ; a spongy and ulcerous 
condition of the gums ; and not unfrequently necrosis of 
the teeth and alveolar, and sometimes of the bones of the 
jaw. 

It is not in the power of the surgeon to counteract the 
evils of this medicine during the process of its operation, or 
by any means to avoid the necessary results of its use ; but 
after its discontinuance, the frequent and most fatal (to the 
teeth) effects that it produces, may, in a great measure, be 
arrested. 

The gums should be treated as in diseases of a corre- 



THE EFFECTS OF MERCURY ON THE TEETH. 57 

sponding character. Astringent washes and frequent 
scarification of the gums will be found highly beneficial. 
To correct the unpleasant foetor that usually attends the 
exhibition of this medicine, a diluted solution of the 
chloride of soda, triturated with the powder of orris root, 
will generally be found effective. In persons of advanced 
ages, the effect upon the teeth is more certain, and a morbid 
condition of the gums is brought about, which soon results 
in a loss of the teeth. As the value and medicinal 
character of mercury is becoming better known and under- 
stood, the use of it is more judiciously resorted to; in con- 
sequence of which, we do not so frequently meet with bad 
results from its administration. 



CHAPTER IV. 



TREATMENT OF CARIES. 

The treatment of caries in the teeth, must be determined 
by the extent of its ravages, and according to the circum- 
stances that have caused it. If it be occasioned by a 
diseased condition of the gums, a restoration to health in 
those parts must be effected, before any permanent relief 
can be obtained. If it is caused by a contiguously de- 
cayed tooth, too much diseased to admit of being filled, it 
should, as an incipient measure, be extracted. Or if a 
crowded condition of the teeth has been the exciting 
cause, the proper means for correcting their irregularity 
should be resorted to. 

Without these preparatory steps, all the operations of 
filing or plugging teeth will avail but little. While the 
cause still remains, the disease will not only continue, but 
will spread until the whole dental system becomes a mass 
of decayed bones — a useless and noxious encumbrance. 

It is not always in the power of the dentist, to pursue 
altogether such a course as his judgment and experience 
would dictate. In such cases, it becomes his duty to point 
out to his patient the proper course, and then be governed 
as far as compatible with his own views, in the treatment 



FILING OF TEETH. 59 

and operations he is called upon to perform. After all the 
necessary preliminaries are accomplished, he is prepared to 
remove or arrest decay by either filing it out entirely, or 
plugging the cavity with some durable metal capable of 
resisting the acrid juices of the mouth ; of which gold only 
should be used, except in very rare cases. Large cavities 
are sometimes considered not worth filling with this metal. 
My own opinion is, that a tooth worthy to be filled, is worth 
filling with gold. When it is past the hope of remedy, it 
had better be extracted, than to prolong the inconveniences 
and evils of it, by useless experiments. 

The operations of filing and plugging teeth, when cor- 
rectly and judiciously performed, will, in a majority of 
cases, successfully arrest the further progress of decay; 
but mal-practice in either, may be productive of more harm 
than good. 



FILING OF TEETH. 

This performance in dental surgery, is susceptible of 
more abuse than any other operation on the teeth ; a fact 
which has led to an unwarrantable degree of opposition : 
for errors in any practice, should not be universal causes of 
condemnation. When properly performed, the experience 
of any practical operator will prove its utility. 

The chief purposes for which teeth should be filed, 
are, to remove superficial caries, to separate teeth that 



60 DENTAL SURGERY. 

require to be filled, so as to give a convenience in the per- 
formance of that operation ; and, occasionally, to make 
room for a clasp to which artificial teeth is to be attached. 

The almost universal habit, of separating sound teeth 
with a file, is a practice, in my humble estimation, much 
to be deprecated, and should be considered a perversion 
of the proper office of the instrument. It is time enough 
to remove the affection when some evidence appears of its 
existence, and not to anticipate, in every case, that which 
occurs in but one of three. Another important objection 
to it, is the vulgar custom of attributing decay to some 
remote dental operation. And as the file has to sustain the 
greatest burthen of the responsibility, when it has been 
used, policy would dictate to us not to sacrifice a useful 
purpose to doubtful and objectionable operations. 

In removing caries with a file, different degrees in the 
cut of them should be used, finishing with the finest ; by 
this procedure the evils commonly arising from the use of 
the file is obviated. The surface is gradually brought to a 
polish, after the main substance is cut away, and finally 
completed by scraping with an edged instrument, and rub- 
bing it with a strip of muslin. 

It is always necessary to avoid removing too much of 
the enamel, thus exposing the bone to the liabilities of 
further decay, and irritation from any thing coming in con- 
tact with it. 

If the decay is only superficial, it may easily be eradi- 
cated with the file, but should it penetrate to any depth, 
recourse must be had to filling. After filing superficial 
caries, it will sometimes be found essential to cut away, 



FILING OF TEETH. 61 

with suitable instruments, such portions of it as would 
otherwise consume too much of the tooth. These instru- 
ments should have round edges, to avoid making acute 
indentations in using them. 

It is frequently necessary to separate the incisores, either 
for the purpose of cutting away a carious part, or to give a 
convenience in filling them, in the performance of which, 
the general appearance and natural form of the teeth should 
not be injured. The posterior part of the incision should 
be made the broadest. 

A file with one safe side, and carried in a lateral posi- 
tion, will most suitably effect this object, and should be 
changed from one tooth to the other, on each side of the 
opening, until completed, unless it be required to cut the 
whole amount from a single tooth. The file should be 
held longitudinally, between the first and second fingers 
and the thumb of the right hand, in first making the 
opening, the operator standing behind the patient ; after 
which, by holding the file at right angles with the hands, 
and standing at the side, he may continue the process 
until finished. 

Spaces cut between the bicuspidati, or molares, should 

form an acute angle at the gum, for which files, cut on 

both sides, radiating at an angle of fifteen degrees, are 

required. If one of the teeth is very much decayed, and 

requires more taken from it than the other, a file (diverging 

at an angle of about thirty degrees) with one safe side will 

be found more suitable. By placing the safe side against 

the sound tooth the decayed portion is easily cut away, and 

a sufficient space is obtained to guard against the liability 
6* 



62 DENTAL SURGERY. 

of decay in the healthy tooth, and to give a proper conve- 
nience for filling the diseased one. An excellent substitute 
for the file-carrier, is obtained in a form given to the handle 
of files, used in operating upon the molar teeth, by which 
a double bend at right angles receives the cheek and 
allows the blade to be exercised at a horizontal level upon 
the teeth. 

When teeth are to be separated for the purpose of 
attaching a clasp, the opening should be made with a flat- 
sided file (cut all over) through to the gum, and then 
enlarged as much as may be necessary ; the corners of the 
cutting edge of the tooth, on the posterior side of the 
aperture, rounded off, and the sharp edges made with the 
file cut away with a scaling instrument. 

If a tooth to be filed is loose in the socket, it should be 
held firm with the fingers of the left hand .during the pro- 
cess of filing. 



FILLING OF TEETH. 

This is an operation, the importance of which the prac- 
tice of many centuries has served to fully establish ; it is a 
custom coeval with the earliest operations on the teeth, and 
if practised at a time when the means and conveniences in 
the performance of it were very imperfect, compared with 
the present age, what must now be its utility, assisted by 



FILLING OF TEETH. 63 

the advancement that has been made, and the increased 
discoveries of the art ? 

The principle is a guarantee, if properly performed, that 
a tooth well filled, is as good as if never decayed, and is 
iully sustained, by the substitution of an indestructive 
material for a corruptible one, in parts most predisposed to 
decay; the effectiveness and success of the operation of 
course depending upon the skill and judgment with which 
it is performed. The causes of failure, and of consequent 
discredit to the operation, is very generally the result of too 
much haste in the execution of it, by which the cavity is 
either unfitly prepared, or the filling inserted in a careless, 
inefficient manner. 

The preparatory process in filling a tooth, is upon the 
surface circumjacent with the decay, by filing it, in order 
to remove the projecting corners that may be presented, or 
for the purpose of obtaining a necessary convenience ; and 
to restore a fair and smooth exterior, evenly assimilating 
in surface with the filling when inserted. 

The next object is to carefully remove all extraneous and 
decayed matter, until the healthy part of the bone is 
exposed, with excavators necessary for the purpose, of 
which the dentist should possess a great variety of sizes. 
Their shape may be confined to a better advantage to 
about eight or ten, than the countless numbers used by 
some operators. 

The simple removal of foreign matter from the cavity is 
not always sufficient ; sometimes it is necessary to alter its 
internal shape to assist in the retention of the filling, which 
is done by the excavators already spoken of. After the 



64 DENTAL SURGERY. 

carious matter is removed from the cavity, it should be 
cleaned out with some cotton dipped in alcohol or cologne, 
and then thoroughly dried before the filling is inserted. 
To prepare a cavity situated upon the side of one of the 
incisores, if, as is generally the case, and without which 
they seldom decay, the teeth press against each other, 
it will be necessary to separate them, as directed at 
page 61, of this work. When a sufficient space is 
obtained, the cavity may be prepared for the plug, by 
entering a straight drill towards the fang, longitudinally 
with the tooth ; then with an excavator whose cutting 
edge inclines towards the shaft of the instrument, the 
lower part of the cavity may be suitably formed. This 
mode of operation, differing a little from that to be gene- 
rally followed, is only necessary when the sides of con- 
tiguous teeth are so near each other, as to preclude the 
possibility of operating upon them in the ordinary way. 

Caries is often found upon the exterior and posterior 
surfaces of the frorit teeth. When it is situated upon the 
exterior, the surface around the cavity should be dressed 
smooth with a very finely cut file, and then polished : the 
edges of the cavity cut evenly with an instrument, and the 
interior excavated under the borders of the decay. 

As the decay generally found on the posterior sides is 
small, not covering much area of surface, a brooch with 
three edges terminating in a point should be inserted, and 
turned round to cut out the fragile and decayed portions on 
the edge of the cavity, and then further prepared with 
excavators, as before described. 

If caries is situated between the bicuspides or molares, 



FILLING OF TEETH. 



65 



upon their lateral surfaces, an opening should be made 
with a file, and the cavity prepared in a suitable manner, 
to enable it to retain the filling. When these teeth are 
decayed in their natural indentations, the edges of the 
cavity should be cut off by twirling the brooch in it, here- 
tofore described. 

It is always proper to avoid, in excavating a cavity 
much decayed, an approach towards the dental canal; for 
by unfortunately making an opening to the nerve, where it 
could* have been avoided, a useful tooth may be injured, or 
rendered almost useless. When the lining membrane is 
exposed, the extreme sensibility of it, and the danger of 
inflammation, forbids the filling of a tooth without pre- 
viously preparing it ; either by cauterizing the nerve, or 
by the application of a shield to protect it from the pres- 
sure of a plug. The channel, by which formations of 
matter are discharged in diseased teeth, being closed, it 
must necessarily collect, and escape through the gum by 
an abscess, or penetrating into the antrum, produce disease 
in that cavity. 

The pressure of a plug upon an exposed nerve is produc- 
tive of inflammation by the irritation which it occasions. 

When a slight exposure of the bone is apparent, or the 
tooth is sensitive upon mere irritation in the bony sub- 
stance, the application of some caustic preparation will 
destroy the sensibility, sufficiently to allow it to be filled 
without pain. 

Of the different articles used for this purpose, I have 
found the white oxide of arsenic, in equal proportions, with 
the sulphate of morphia, to be the most certain. 



66 DENTAL SURGERY. 

The extract of cicuta, pure arsenic, and kreosote, in 
equal quantities, is used by some operators altogether. 

The oil of ergot, I have found in some cases singularly 
effective, having the peculiar quality of decomposing the 
membrane, without producing inflammation of the remain- 
ing part. Great care should be. exercised in the introduc- 
tion into the mouth of any powerful cautery ; no more 
should be used than sufficient to cover the exposed nerve, 
and should be placed on a very small piece of cotton, 
previously saturated with alcohol or water, forced into the 
cavity as far as possible, and covered with softened bees- 
wax. A small towel should defend the mouth from any 
particles that may accidentally fall in the process of 
insertion. 

Of the danger attending the use of cauteries applied to 
diseased teeth, several instances have come to my know- 
ledge — the two following circumstances will be sufficient to 
show the fearful consequences that may attend their appli- 
cation. 

A friend related to me the occurrence of a case, by 
which a young man in the State of Connecticut lost his 
life. Having called upon a dentist for the purpose of get- 
ting a tooth extracted, he advised him to save it by having 
the nerve destroyed, and the tooth filled ; anxious to pre- 
serve a valuable member, and, at the same time, forego the 
dreaded pain of extraction, he consented ; but from the 
inefficent manner of its application, or some unavoidable 
cause, he swallowed the preparation inserted for the pur- 
pose, a few hours afterward, resulting fatally, before the 
effects could be counteracted. 



FILLING OF TEETH. 67 

The same gentleman related another instance, of a promi- 
nent literary man from one of the Eastern States ; who, 
while on a visit to London, applied to a dentist to operate 
-on his teeth : in one of them he placed a cautery of some 
kind, which acted so powerfully on the nervous system as 
to deprive him almost entirely of his physical energies, and 
he is now a shattered wreck of his former self. 

It is not always necessary to remove by cautery any 
slight sensibility existing, whether occasioned by irritation 
of the bony substance, or the remains of a thin plate of 
bone covering the dental cavity ; in the first case, but 
seldom any inconvenience is felt after the tooth is filled ; 
in the latter, as well as in cases in which the natural canal 
is open, pressure may be obviated by inserting a convex 
cap of gold over the opening ; if inflammation is to be 
apprehended, a small tube soldered in the cap and cut off 
flush with the surface of the plug, will allow the discharge 
of any matter that may form, and by that means prevent 
the difficulties that generally attend the entire stoppage of 
such teeth. 

It is not my purpose to recommend the filling of teeth, 
where the nerve has been exposed ; at the best, it is an 
uncertain operation, and fails more frequently than it is 
successful ; my only reason for ever resorting to it, has 
arisen from the local value of the tooth, either by its 
exposed situation or importance in mastication. 

Of the different materials that have been employed for 
filling decayed teeth, gold stands pre-eminent, as it will 
resist the action of every thing that can be held in the 
mouth, and its great malleability admits of its being beaten 



68 



DENTAL SURGERY. 



to any required size, suitable for dental purposes. Of the 
different sizes manufactured, the operator will sometimes 
find occasion for three numbers — four, six and eight ; for 
general practice No. 6 is preferable ; for very small cavities 
No. 4 is convenient, and for the larger ones No. 8 should 
be used. The numbers are regulated according to the 
grains in a sheet. The baser metals are used to a limited 
extent — principally tin and silver — and a cement of 
silver amalgamated with mercury, the alloy, known as 
tutenag, has been recommended. I have never seen a case 
of its application to my knowledge ; its utility cannot, in 
opposition to other known remedies, for a moment be 
admitted. 

Cement, for teeth presenting a mere shell, or for roots that 
a patient may be anxious to retain, will be found highly 
useful, and not as objectionable as is generally imagined ; 
it can be applied without the preparation that should be 
exercised previous to filling with other substances, and 
soon acquires a hardness that will resist any ordinary attri- 
tion. I have used it in large quantities, and have never 
found any bad effects from it ; it is also used by many 
practitioners whose celebrity should entitle their judg- 
ment to some respect ; by their practice, they must 
agree with me, in the utility and harmlessness of it ; 
the small amount of mercury retained in the amal- 
gam properly prepared, is proven, by actual experi- 
ment, to be about four grains to the hundred, and in 
six or eight large cavities would not exceed the ordinary 
dose of mercury for an adult, taken into the stomach. It 
is prepared by granulating the silver with a fine file, and 



FILLING OF TEETH. 69 

rubbing it with an equal amount of quicksilver in a small 
mortar ; when sufficiently united it is to be transferred to a 
piece of sheepskin, and wrung as long as any of the mercury 
will ooze out. No more should be made at one time, than 
is needed for immediate use, nor should the same material 
be used a second time. 

It is only necessary in preparing a tooth for the reception 
of cement, that the extraneous matter be removed from the 
cavity ; teeth filled with it, being almost worthless and very 
much decayed, will not generally admit of the same pre- 
paration that should be given to others less sensitive, and 
worthy of a better substitute. This article should not be 
used in teeth, in which the lining membrane is exposed ; 
in the event of inflammation, owing to its solidity, it is with 
difficulty removed. 

In selecting gold foil, that which is soft and well annealed 
should be preferred ; if too hard, it is liable to crumble in 
the insertion of it. 

A sheet of foil should be cut into strips, from a half to 
the twelfth of a sheet, and crumpled lengthwise — not rolled 
or twisted — it is then to be cut into pieces half an inch in 
length, pinching or twisting the end to a point before cut- 
ting it off. These plugs may be kept in a partitioned box, 
assorted according to their sizes, using the smaller ones 
for small cavities, and the larger for large cavities, dis- 
criminating according to the decay to be filled. 

In filling the incisores or cuspidati on their lateral 
surfaces, a piece of gold is inserted with a small pair of 
dissecting forceps, and with a straight plugger forced into 

the cavity, until about two-thirds is entered ; another piece 

7 



70 DENTAL SURGERY. 

is introduced under the first in the same way, unless the 
cavity is very small. The second piece is then entered in 
the hole left by the plugger, and so continued, in either 
process, until a sufficiency is inserted ; the external ends 
are then turned in, and are forced together with a flat-sided 
plugger, either straight or bent at an angle. To finish ; the 
surplus is carefully removed with a file or small scraper, 
and then smoothly burnished. To fill large cavities more 
fully exposed, and easier of access, such, for example, as 
those on the grinding surface, or the front of the molar 
teeth, the plugs of foil should be placed in, and around the 
circumference of the cavity until it is full, and a straight 
plugger with a short handle held in the centre. The gold 
is to be forced in all around it. Finally a piece is inserted 
in the opening in the centre, and the whole pressed into a 
solid body. 

For filling decays on the posterior side of the molar 
teeth, pluggers with a double curve or bend are necessary ; 
in such cases, it is more convenient that the gold be applied 
in one strip. 

It will generally be found necessary to protect the plug 
from the saliva, by the use of a soft towel, held in the 
mouth with the left hand. 

I have often found it convenient to wedge the front teeth 
apart, to get at the decays more easily. 

As success in the operation of filling teeth, depends in a 
measure upon the purity and preparation of the foil, the 
dentist cannot be too particular in the choice of it. Mr. 
Hastings, of North Fifth Street, above Race, Philadelphia, 
has furnished me with what I have used for several years, 
and with entire satisfaction. 



SCALING OF TEETH. 71 

SCALING OF TEETH. 

The operation of scaling, applies to the removal of all 
extraneous matter from the surfaces and interstices of the 
human teeth ; and is, if carefully performed, generally 
attended with beneficial results. A careless or awkward 
use of the scaler has, in many instances, produced inju- 
rious effects, and frequently proved an incipient cause of 
decay. One of the numerous evidences, that I have 
witnessed in the course of my practice, is related at page 
48. For the removal of tartar and other foreign matter, 
to be found on the teeth, other remedies are resorted to, of 
which suitable dentifrices, prepared without the admixture 
of any thing calculated to operate on the teeth by any 
other means than that of friction, is injurious. All sol- 
vents should be discarded ; the mineral acids are fre- 
quently used, and hawked about by empirical knaves, who, 
regardless of their effects, are willing to sacrifice a valuable 
set of teeth for a mere pecuniary pittance, gained in their 
pernicious traffic. 

Tartar is sometimes found to have accumulated to an ex- 
tent sufficient to produce deformity of the mouth. One very 
remarkable instance I will relate, that occurred a few years 
since ; the subject was a grocer; I mention his calling, for 
to that fact, I attribute the means that led to the occur- 
rence. 

The patient, a young man, consulted me for the purpose 
of having the four superior incisores artificially inserted. I 
was struck, at first sight of him, by a remarkable protrusion 
of the lower lip, which, to my surprise, upon examination, 



72 DENTAL SURGERY. 

I found to be occasioned by an immense accumulation of 
tartar, to the amount of at least one-fourth of an ounce, 
when removed from the anterior and posterior surfaces of 
the inferior incisores and cuspidati. Two years subse- 
quently he again called, with his mouth in the same condi- 
tion as before, except that the matter was less concrete 
than upon the first occasion. The cause of this deposite 
originated, doubtless, from the glutinous character of sub- 
stances he was in the habit of constantly chewing, the 
convenient access to which was obtained from among the 
goods sold in his store, such, for instance, as cheese, sugar, 
etc. A little cleanliness on his part, might have prevented 
the disgustful results of such negligence ; according to his 
own admission, he never used a tooth-brush. 

For scaling the teeth, two varieties of instruments only 
are necessary, of different sizes ; the round edge, and the 
two-sided ending in a point. The first is of different cur- 
vatures, and the latter forming a right angle with the shaft, 
the end of which is screwed or riveted into the small plate, 
of which the blade of the instrument is made. A very 
common form in present use, is a sharp-pointed curve, 
affording no convenience or preference over the others, in 
my opinion. Those above described, I conceive to be 
sufficient, if dexterously used, for any purpose. 

The scaler should be held between the three last fingers 
and thumb of the right hand, using the forefinger as a 
purchase, and resting it upon the tooth to be operated 
on ; then, by a contractile motion of the fingers, the 
instrument is brought to act upon the teeth. 

A degree of caution is necessary, to avoid injuring the 



SCALING OF TEETH. 



73 



gums. The scaler should be gently forced under the gum, 
to completely remove all tartar that may be deposited 
there ; the remains of a small portion of which, may serve 
to keep up an irritation, or be the means of a new for- 
mation. 

The position of the operator, in scaling the upper teeth, 
should be upon the right side of the patient, holding the 
lip out of the way with the thumb of the left hand ; and 
commencing with the tooth posteriorly situated, with a 
round-edged instrument, carefully remove from the surfaces 
all the adhering tartar. After traversing the entire dental 
circle, he should return, and with a pointed scaler dislodge 
any portion that may remain between the teeth or under 
the gum. Sometimes it is more necessary to commence 
operations with the pointed instrument, particularly when 
the deposite is hard, and situated more directly under 
the gums, a single quick motion with which, will frequently 
scale off large flakes ; frequently bringing it all away at a 
single movement. 

In scaling the lower teeth, the dentist should stand a 
little to the left, behind the patient, except when operating 
upon the front surface of the bicuspides and molares of the 
right side, and the right side of the inner surfaces of the 
front teeth, when it will be found more convenient to stand 
on the right. Occasional deviations from these general 
rules will be found necessary, of which the convenience to 
the operator will be his best guide. After performing all 
that can be done with the instrument, the sides of the 
teeth may be polished, by rubbing between them strips of 
muslin, until perfectly cleaned. 



74 DENTAL SURGERY. 

When the process of scaling is completed, the teeth 
should be brushed thoroughly with a suitable dentifrice, 
and the mouth occasionally rinsed with some tonic or 
astringent wash. The importance of a constant use of the 
brush and dentifrice, at least three or four times a week, 
should be urged. Small brushes, having only a tuft of 
bristles at the end, will be found very convenient for 
brushing the insides of the teeth, particularly the lower 
front teeth, which are very liable to accumulations of 
tartar, and cannot easily be got at with the ordinary kind 
of brush. 






CHAPTER V. 



ODONTALGIA. 

" But tooth-ache, hell o' a' diseases! 
Aye mocks our groans !" 

The poet has very significantly and energetically por- 
trayed the horrors of this dread king of scourges ; of which 
the life of almost every member of the human family, has, 
at some time, borne evidence by a painful experience to its 
tormenting and torturing miseries. It commences with the 
tender infant, ere yet it has learned to know the cause, and 
continuing from infancy to youth and maturity, at intervals 
of a long or shorter duration, is finally disposed of, only by 
the loss of the last vestige of those members, which, barring 
their inconveniences, have afforded us, through a long life, 
the means of contributing to its nourishment and support. 
When the malady is situated in the primary set of teeth, it 
is attended with a feverish uneasiness, and the severe con- 
stitutional derangement that occurs, renders the extraction 
of the tooth positively necessary, unless the pain can be 
subdued by a local treatment ; the continuance of which 
will undeniably exercise an influence upon the disposition, 
of an ultimate tendency, much to be regretted. 



76 DENTAL SURGERY. 

The effect of the pain of a violently aching tooth, witn 
those of riper years, is also productive of serious conse- 
quences, and with persons of a sensitively nervous tempera- 
ment, has, in many instances, produced results of a very 
serious character. 

The toothache is believed to be unparalleled by any other 
pain, in the catalogue of human sufferings, and its conse- 
quences, in the absence of the necessary means of relief, 
fearful, and though probably not immediately or directly, 
but eventually, fatal. 

Pain in the teeth arises from inflammation of the lining 
or investing membranes of the tooth affected ; and some- 
times by a sympathizing nervous irritation proceeding from 
another tooth. Another character of pain is sympathetic, 
arising from a disordered nervous temperament, or a 
vitiated state of the stomach. Pregnant women are also 
often afflicted with periodical achings of the teeth, some- 
times continuing for weeks after delivery, and often 
centered in teeth perfectly sound. 

" We frequently see pain centre itself in the tooth, when 
the uterus is undergoing changes, and the gums assume a 
swollen condition, sympathizing with the physiological 
state of that organ ; nor is it less remarkable, that in 
delicate females, the nerve of a tooth being irritated, the 
uterus sympathizes to so great an extent, that miscarriage 
is frequently produced." 

The exposure of the lining membrane is generally 
attended with an acute, darting, throbbing pain ; the 
irritation produced by the pressure of any foreign matter 
upon it, when the dental canal becomes opened, renders it 



ODONTALGIA. 77 

liable to such severe and sudden sensations. That of the 
membranes of the periosteum and alveolar, is not so violent, 
but generally more protracted ; the first, by its severity, 
impels us to some speedy means of relief, while the latter 
may exist for several days, without receiving any efficient 
treatment. 

When the membranes of the periosteum or alveolar are 
affected, if allowed to continue uninterrupted, a conse- 
quence will frequently result, prejudicial to the permanence 
and health of the teeth. 

In the treatment of an aching tooth, the first step is to 
remove the cause ; if produced by an exposure of the lining 
membrane, the only certain and permanent remedy, is an 
extraction of the diseased tooth ; the pain may sometimes 
be relieved by the application of soothing agents, such as 
opium, kreosote, the oil of ergot, &c. ; the preparation of 
arsenic and morphia, recommended for destroying the 
nerve, is more efficacious in the destruction of that mem- 
brane, than any thing else I have ever tried ; but as has 
already been stated, is objectionable from the inflammation 
which is likely to ensue ; it is very severe during the time 
of its operation, making " the remedy worse than the 
disease." The most effectual method of destroying sensi- 
bility, is by the insertion of a heated needle, which, from 
the situation of other teeth in the mouth, and the diverging 
form of the fangs, cannot be used in any but the incisores 
and cuspidati. 

The front teeth, from the convenience of grafting upon 
them artificial crowns, are too valuable to admit of their 
extraction; occasional cases occur, when the inflammation 



78 DENTAL SURGERY. 

has proceeded so far, as to render that operation fruitless ; 
then no other resource is left for success, but the removal 
of the entire tooth. 

When toothache arises from inflammation of the invest- 
ing membranes, or those of the alveolar, a loss of blood from 
the parts, will sometimes give relief; the gums should also 
be bathed with the following, diluted as used, with three 
times its bulk of warm water : 

R. 01. Sassafras, ----- ^ss. 

Tinct Myrrhi, 3j. 

Misce. 

If the pain is occasioned by a disordered condition of the 
stomach, the administration of epsom salts, magnesia, or 
some other gentle cathartic, will generally procure relief. 

The operation of starting a tooth from its socket, is but 
a futile and frequently a pernicious practice ; if it is suffi- 
ciently dislodged to sever the connection with the vessels 
of the alveolar, the tooth becomes at once an extraneous 
body, and liable to all the evils of such ; it therefore can 
never be performed with any hope of entire success. 



EXTRACTING TEETH. 79 



EXTRACTING TEETH. 



This operation is the dernier resort in incurable 
diseases of the teeth ; upon the proper performance of it 
depends the ease and relief to the patient. No dental 
operation is more simple when properly understood, and 
none more serious in its consequences when unskilfully 
done. The blunders committed by the various kinds of 
practitioners that have exercised this branch of dental sur- 
gery, from the strong arm of the blacksmith, to the puny 
brachia of a barber's apprentice, have entailed upon many 
who have been so unfortunate as to come under their 
influence, misery and suffering, and sometimes horrid 
deformity to the ends of their life. It is a lamentable fact, 
that practitioners in medicine, generally, have neglected to 
acquire a proper knowledge of the manipulations in this 
operation, and, for the want of a little practical informa- 
tion, fail in almost every effort. To them is allotted a 
frequent occasion for extracting teeth, and consequently a 
necessity for skill in the performance of it. 

Numerous cases of fractures of the teeth and alveoli, 
and sometimes of the bone, have been presented to me, 
and many others of a serious character have been noticed 
by different writers. Upon one occasion, a lady from the 
Eastern Shore of Maryland exhibited to me a tooth with a 
large piece of the inferior maxilla, that had been broken in 
its extraction. She endured excruciating pain for some 
time, and finally recovered with a lasting deformity of the 
face. Mr. M., a gentleman well known in the mercantile 
community at Philadelphia, carries with him a conspicuous 



80 DENTAL SURGERY. 

evidence of mal-treatraent in the extracting of a tooth. 
And almost every day reveals the suffering of some martyr, 
to the brutal ignorance of a tooth-puller. 

The instruments now in general use, for the extracting 
of teeth, are the preparatory, or gum lance, key, forceps, 
punch, screw, and thumb-elevator. 



THE LANCET. 

Success in the extracting of teeth depends, in a great 
measure, upon the proper excision of the gums. First, 
because it disengages the tooth from its connection wilh 
the gum ; and, secondly, it affords a better opportunity to 
embrace the neck of the tooth with the extracting instru- 
ment. 

Dr. Thomas Bell discourages the use of the lancet, and 
says, " that it can in any way facilitate the removal of the 
tooth from the socket, is too obviously absurd to require 
refutation ;" and as strangely at variance with anatomical 
facts, and practical experience, as his theory is, there are, 
notwithstanding, a few operators of the present day that 
are proselytes to it. 

A strange pertinacity to operate differently from the 
" common herd," I conceive to be an exciting motive for 
such derelictions. 

The gum is firmly attached to the neck of the tooth 
which it embraces, and without this preliminary measure, 



THE LANCET. 81 

is liable to be torn away with the tooth, upon its extraction ; 
besides, roots of teeth are often so completely invested by 
the gums, as to otherwise preclude any opportunity of 
securing a hold sufficient to remove them. 

The practice is in opposition to my judgment, and, con- 
sequently, I have never experienced an instance of its bad 
effects. A note before me, from a medical friend of this 
place, refers to a case, in which he says that he once saw 
an entire denudation of the alveoli, occasioned by extract- 
ing a tooth without previously lancing the gum. 

The extraction of deciduous teeth never require it, the 
adhesion of the gum being so imperfect. 

The lancet should always be applied as deeply 
towards the socket of the tooth as possible, both on the 
external and internal margins, and also between the teeth. 
Two varieties of lance are necessary ; the straight-edge end- 
ing in a round point, adapted to the superior and inferior 
incisores, cuspidati, and bicuspides ; and another, with the 
blade describing an angle of 45° from the shaft of the 
instrument, designed for separating the gum around the 
molar teeth. The instrument should always be examined 
previously to using it, and keenly sharpened. 



8 



82 



DENTAL SURGERY. 



THE KEY. 



The key is the oldest accredited instrument for the pur- 
pose, now in use, and may, with propriety, be considered 
the universal tooth-extractor; for with it, a greater facility in 
general practice is obtained, than with any other kind. In 
the hands of an unskilful operator much injury may be 
done by the key. The results commonly attending an 
awkward application of it, are an excision of the crown, 
and consequent exposure of the pulp of the tooth ; a 
crushing of the alveoli, a fracture of the bone, and some- 
times the extraction of two teeth instead of one. 

An important service of the key, is the facility furnished 
by it for extracting roots of teeth when too much broken 
or decayed off to admit the application of the forceps, or 
so situated, as to render the inconvenience of access a 
bar to the use of a punch, or thumb fulcrum. It is, in 
fact, only upon such occasions that I ever use it. When 
enough of the solid bone of the tooth remains to afford a 
necessary hold for the forceps, the conveniences and pre- 
ferences belonging to them, invariably impels me to choose 
them rather than the key. 

In the selection of this instrument, more regard should 
be paid to its simplicity than complication of style ; the 
various crooks and bends of the shaft, and different 
arrangements of the bolster or fulcrum, only tend to con- 
fuse the operator, and in the adjustment of the instrument, 
to detract his attention from its most important purpose ; 
besides, many of them are calculated, from their peculiar 



THE KEY. 



83 



forms, to render the hand unsteady and uncertain in its 
operation. 

The set which I have, are of the same form as used by 
my deceased parent for twenty-five years, and my own 
estimate of their correctness, warrants me in the belief that 
others may find them more serviceable and convenient than 
the generality of those made at the present day. 

Plate 1, fig. 3, is the largest size, and is four inches long 
in the shaft, from the handle to a quarter inch bend at an 
angle of 45°, and then continued parallel with the shaft, 
one inch to the end in which the screw is fastened, to hold 
the hook. The fulcrum is flat, slightly depressed on its 
sides, and rounded on the lower edges. 

This form and size of the key is adapted to the extrac- 
tion of the lower molares. 

. Fig. 2 has a straight shaft, with a larger fulcrum than 
fig. 3. This is designed foi the removal of the first and 
second superior molares, and the bicuspides of both jaws. 
The front teeth, when necessary to use the key in their 
extraction, may also be removed with the same instru- 
ment. 

Fig. 4 may be shaped in every respect like fig. 2, 
though much smaller in the fulcrum ; it is used exclu- 
sively for extracting the dentes sapientise. Those teeth 
being situated at the angle of the jaw, where the bone and 
sockets are shallow, and the tooth almost entirely invested 
by the soft parts, require the fulcrum to be of the smallest 
possible size. 

In regard to the form of the fulcrum there ought to be 
but one opinion ; the objections to the round one, and 



84 



DENTAL SURGERY. 



advantages of the flat, must be evident to any practical 
operator or reflecting mind. The pressure of a cylindrical 
body upon a flat one must be confined to a very small 
space, and upon a surface rather convex than otherwise, 
the pressure would necessarily be still more limited. This 
is not the only, though a sufficient objection ; it is almost 
impossible to retain a round fulcrum where it should be, for 
it is constantly liable to slip from its position. The only 
advantages of it are fully met in the flat fulcrum, by wrap- 
ping it with muslin, and rounding the edges of it, to 
prevent injury to the gum. 

The hook is the next principal feature to be noticed in 
the key, for without a proper regard to its peculiar points, 
the instrument becomes inefficient, and dangerous in its 
application. Two specific objects should be observed ; 
the first is the form and size, and the second the condition 
of the edge or points. The curvature of the hook .should 
be sufficient to make it clear entirely the crown of the 
tooth, and no longer than actually necessary; by which 
means more power is obtained with less pressure upon the 
gum, the fulcrum being brought nearer to the crown or 
surface of a broken fang ; a very important feature in the 
use of the key. The edge should be made sharp, with a 
short bevil, to avoid the liability of breaking in the opera- 
tion. If the instrument is dull, it is liable to slide from its 
proper place on the fang, and endanger an excision of the 
crown. 

Preparatory to applying the key, the fulcrum should be 
wrapped with a strip of muslin, half an inch in width, 
carrying it alternately on each side of the hook, and 



THE KEY. 



85 



occasionally transversely around the fulcrum, terminating 
with the end wrapped around the shaft, and held under the 
finger. 

The key should be grasped, with the handle between 
the thumb and three last fingers of the right hand, and 
the forefinger resting horizontally upon the shaft. 

After the gum is properly lanced, the hook should be 
inserted far upon the neck of the tooth, to the alveoli, and 
the fulcrum sustained as nearly opposite as possible, avoid- 
ing to let it settle down upon the gum, and produce the 
unfortunate results that usually attend such a situation 
of it ; then gently rotating the instrument, and pressing 
with the forefinger of the left hand upon the hook until it 
is felt to take hold ; after which, continuing the raising 
power, the tooth will be started from its socket ; at this 
juncture, some writers have directed a sudden elevating 
motion to the key, which, unless the tooth is entirely dis- 
engaged, may be attended with unpleasant results. The 
most safe and certain method, is to use a pair of forceps ; 
previously reconciling the patient, by a simple statement of 
the truth, that the tooth is loosened from the socket ; in a 
large majority of cases, no succeeding attempt is necessary, 
as the tooth will come out with the key. 

It has been a matter of dispute, which side of the tooth 
the fulcrum should be placed, though without any just 
causes of doubt; the position of the teeth, together with 
the anatomical arrangement of them in the jaw, seem to 
me to afford a sufficient guide, to preclude the possibility 
of error ; the upper teeth having their inclination out- 
ward, would most certainly indicate their easiest extrac- 



86 DENTAL SURGERY. 

tion in that way, and consequently with the fulcrum placed 
upon the outside. 

Mr. Bell,* in referring to the extraction of the first and 
second molares of the upper jaw, says that "the fulcrum 
should always, if possible, be placed on the inner or pala- 
tine side;" and subsequently goes on to say, " The appli- 
cation of the fulcrum to the outer side, as recommended by 
most writers on this subject, appears to me to be a very 
important error. Not only is the instrument much more 
readily fixed in the situation which I have directed, but the 
basis on which the fulcrum rests is more firm and solid. 
If the fulcrum be fixed on the outer alveolar plate, it will 
certainly pass upwards during the turn of the instrument, 
and fracture of the process is almost inevitable. On the 
inner side, on the contrary, there is a firm, solid, and suffi- 
ciently broad basis for the fulcrum to rest upon, and, as it 
is thus prevented from rising whilst the instrument is turned, 
the oval of the fulcrum presents a higher and higher por- 
tion to the place on which it rests; thus assisting the 
extraction in the very direction in which it is required." 
The arguments offered by Mr. Bell, to substantiate the 
truths of his practice, do not, in my opinion, sustain them- 
selves by facts. In the first place, the ready convenience of 
fixing the fulcrum, is as great upon the outside of the tooth 
as the inner, and the position of it more firm and steady ; 
if placed upon the palatine side, it rests upon an incline 
plane ; whereas, on the outside, the surface is nearly per- 
pendicular, and consequently parallel with the raising 
power, by which the instrument can be managed with 

* Bell on the Teeth, p 298. 



THE KEY. 87 

more firmness, and less liability to slip, than if applied upon 
the inner side. As to the danger of the fulcrum passing 
upward, during the turn of the instrument, there is none, 
no matter which side of the tooth it is placed, provided 
the hook is short enough, and the flat fulcrum be used, 
unless so much of that side of the crown be broken or 
decayed away; in that case, another mode of operating 
will be found upon a subsequent page. 

In the extraction of the lower teeth, I again differ with 
the highly respectable operator recently quoted : by placing 
the fulcrum upon the inside of those teeth, when it is possi- 
ble ; the objections given by him to this mode of operating, 
are counteracted in the proper form of the hook, and its 
correct application to the tooth ; it w T ill be observed, that 
if the instrument is properly applied, the first motion given 
to the tooth is a perpendicular one, and after it has pro- 
gressed a little, or until the edge of the claw becomes oppo- 
site the centre of the counter-force of the leverage, it begins 
to describe the arc of a circle ; and then being sufficiently 
elevated to clear the edge of the alveoli, is assisted by the 
direction of the articulation of the tooth. 

The superior wisdom teeth always require that the fulc- 
rum be placed upon the outside, their inclination generally 
being outward, and the delicate character of the maxillary 
bone rendering it so liable to being broken ; many cases of 
which I have seen, from the application of the instrument 
upon the inside. The wisdom teeth of the lower jaw may 
more determine the position of the fulcrum, by their situa- 
tion or peculiar inclination, it varying so much in different 
mouths, than by any fixed rule. 



88 



DENTAL SURGERY. 



For the extraction of the superior incisores and cuspidati, 
the fulcrum should be placed on the inside, as also in 
removing the bicuspides. 

The deciduous teeth rarely, if ever, require the aid of the 
key; in fact, the injury that may arise from the use of it, 
should entirely forbid it, in the extraction of these teeth. 

For the removal of broken or decayed fangs, the key 
is invaluable ; in a majority of cases, other instruments 
that are made expressly for the purpose, will conveniently 
and safely effect the objecf ; but the roots of molar teeth, 
that are firmly set, will sometimes resist all efforts with 
a punch or elevator, and can only be extracted with safety 
by means of the key. 

If the gum entirely invests the fang, it should be incised 
longitudinally with the root, until a proper opportunity is 
afforded for taking hold with the claw of the instrument ; 
as upon the first seizure, depends the success, very fre- 
quently, of the operation ; should the fang be broken off, a 
greater difficulty will occur to obtain a second fastening. 

The operator will frequently meet with cases, where one 
half of a crown will be found broken off, together with a 
large portion of that side of the fang, thus occasioning a 
hollow place, into which the fulcrum is liable to slip, and 
by that means lose the necessary purchase ; such a difficulty 
may be remedied, by using hooks with a double bend at 
right angles, which is calculated to throw the fulcrum 
against a posterior or an anterior tooth. 

The position of the operator must be determined, prin- 
cipally by his own experience, in the one most convenient 
to him. As a general rule, in the extracting of the upper 



THE FORCEPS. 89 

and lower bicuspidati and molares, and the cuspidati and 
incisores of the left upper and lower jaws, he should stand 
upon the right of the patient, a little in advance ; and in 
removing the incisores and cuspidati of the right side of 
either jaw, his position should be upon the left. 



THE FORCEPS. 

The forceps have almost superceded the key for the 
extracting of teeth ; they are applied without any depend- 
ance upon the gum or adjacent teeth, and with less pain 
than generally attends the use of the key. 

A large variety of forceps are now in use, many of them 
well suited to the extraction of the different teeth for which 
they are designed. More care and attention to the peculiar 
adaptation of the instrument to the convenience of the hand, 
and the application of it to the teeth, is now observed in 
the form of the forceps than formerly, and any operator may 
be able to select an assortment in every way appropriate to 
the extraction of all the teeth, from the incisores to the 
molares. The ingenuity exhibited by some of the artificers 
in dental instruments, is worthy of much commendation, 
for to the combination of ideas, gathered by them from dif- 
ferent operators, many of the improvements may be referred. 
Mr. Kern, of North Eighth Street, Philadelphia, has attained 
a celebrity to which he is well entitled. By my own obser- 



90 



DENTAL SUKGERY. 



vation, I am satisfied that the reputation of a dental surgeon 
may suffer from the use of bad instruments. 

One general fault in the construction of the forceps, is 
the want of sufficient excavation in the bowl of the claw, 
to allow them to grasp the neck of a tooth, without the 
liability of crushing the crown ; another, is in making the 
nibs, or points, too long and slender, by which they are 
oftentimes either broken in the application of them or pene- 
trating too deeply in the fang of the tooth, endanger the 
splitting of it. 

For general practice, the operator should possess at least 
nine pair. One pair of straight forceps, designed for 
removing the upper and lower incisors and cuspidati. 
These forceps should be slightly indented in the claw, and 
a little concave at the points. For the extraction of the 
superior bicuspidati, two pair are necessary, one for each 
side, having a double curve to throw the jaws of the for- 
ceps horizontal with the tooth. Similar forceps may be used 
for extracting the molars, having longer curves, and of a 
larger size in the claw; these forceps should terminate in 
the inner claw, with two points, corresponding with the 
inner fangs of the molar teeth ; the outer claw should ter- 
minate with two grooves similar to the fangs on the outside 
of those teeth. 

The forceps for removing the lower molares, may be of 
similar construction, except in the terminus of the claw, 
which, to correspond with the form of the roots, there being 
two ranging posteriorly, one with the other, should termi- 
nate each in two grooves having three points. 

For extracting the lower bicuspidati, a pair of the ordi- 



THE FORCEPS. 91 

nary " hawk-bill," as recommended by Mr. Bell, are 
necessary. 

The incisores and cuspidati of the lower jaw may be 
more safely extracted with forceps of the following descrip- 
tion. I consider them superior to the narrow beak hawk- 
bill, inasmuch as the application and use of them is more 
consistent with the range and situation of those teeth. The 
jaws are narrow, terminating in one groove; from the hinge 
the handles are curved outward, the outer handle continuing 
the curve to the end ; the inner handle, one inch from the 
hinge, curves inward, and terminating with the end in- 
clining to the outer handle.* 

For removing deciduous teeth, three pair only are 
• needed ; one pair similar in construction to those last de- 
scribed for extracting the lower front teeth. 

One pair of small straight forceps for the upper front 
teeth and small grinders ; and one pair bent at right angles, 
or nearly so, with the edge of the handle. In the use of 
the forceps, the operator must generally decide according 
to the greatest convenience in performing the operation, 
his relative position with the patient. As a general rule, 
the right side is to be preferred, as it gives an opportunity 
to support the head with the left hand. A few hints, how- 
ever, may not be unacceptable, of the positions most conve- 
nient for the proper performance of this part of dental surgery. 
To extract the incisores, cuspidati, bicuspides, and 
molars of the left side of the upper jaw, the dentist should 
stand on the right side, at an angle of forty-five degrees 
front of a line parallel with the back of the patient. 
* Vide plate 3, fig. 1. 



92 



DENTAL SURGERY. 



To extract the bicuspides and molars of the right side, 
he should stand on the right, nearly in a line with the 
patient. 

In removing the inferior bicuspidati and molars of the 
right side, his position should be in the rear, elevated so, 
that with the left hand situated on the left of the patient, 
he may be able to hold away the lips, and apply the forceps 
upon the teeth, bending over the head of the subject. 

The same position is necessary for extracting the lower 
front teeth. The removal of the inferior bicuspides and 
molars require that the operator stand upon the left side. 

Before applying the forceps, the gums should be sepa- 
rated from the neck of the teeth as thoroughly as possible, 
and if the crown is much decayed, an incision should be 
made parallel with the fang, to admit of the instrument 
entering far on the neck of the tooth, to guard against any 
danger of breaking it; the forceps should, in every case, 
be forced upon the fang as far as possible. 

A frequent cause of accident in the use of this instru- 
ment, is the unrestrained pressure applied upon the tooth. 
Many operators grasp the forceps with clenched hands, as 
if they were extracting a spike from an oak plank, and thus 
frequently excise the crown of very solid teeth. To avoid 
this liability, the first and second fingers should be placed 
on the inside of the handles, one to act upon each in 
restraining the power, by which means a proper control is 
exercised in the pressure of the instrument ; sufficient 
force only should be applied to retain hold upon the teeth. 

In extracting the front teeth, a slightly rotary motion 
facilitates very much their removal. Those teeth which 



THE PUNCH. 93 

have more than one fang, require that an undulating motion 
be given to separate the walls of the alveoli. 

Deciduous teeth demand the utmost care to avoid injury 
to the approaching permanent set ; they do not require any 
preparatory separation of the gum. 



THE PUNCH. 

The punch is designed for removing broken or decayed 
fangs, unfit to be extracted by the forceps or key ; to 
avoid injury to the mouth, some operators recommend the 
insertion of a towel, so arranged as to receive the point of 
the instrument, in the event of its slipping. In the use of 
this instrument, the operator should firmly brace the head 
with the left arm ; and with the right arm resting against 
his body, any undue force or sudden motion may be pre- 
vented, with more certainty and safety, than by a mere 
dependence upon any thing placed in the mouth. The 
instrument is a dangerous one,, and should be used with 
caution. 

The punch I employ for the purpose, is of a different 
construction from the ordinary one : having the point a 
little curved ; with it, a leverage is obtained, and less 
danger exists in its use. 



94 DENTAL SURGERY. 



THE SCREW. 



This instrument is used for extracting the roots of front 
teeth, that have had artificial crowns inserted on them, and 
will be found very convenient, particularly when too much 
decayed for the key. It is applied, by gently screwing it 
into the cavity of the fang, until a sufficient hold is ob- 
tained to bear the force of extraction. Sometimes it is 
necessary to enlarge or deepen the hole with a drill. 



THE THUMB-FULCRUM. 

This is the most convenient instrument in general use 
for extracting fangs of teeth, and may sometimes be em- 
ployed advantageously in removing teeth that are entire ; 
the form is a bend at right angles of about five-eighths of 
an inch, from a shaft of two and a half or three inches, 
with a short handle ; the bend should also have a slight 
inclination at the end, which should be at least the eighth 
of an inch in width, and made very sharp ; this is the 
description of the primitive instrument, and is in every 
respect preferable to the modern one. In the application 
of the thumb-fulcrum, the gum should be well lanced, and 
the hook forced as deep upon the neck of the tooth as pos- 
sible ; the operator placing himself in the position directed 
for the punch, with it may easily remove a very firm tooth ; 



EXCESSIVE HEMORRHAGE FROM EXTRACTION. 95 

by this position, an acquisition of power is obtained, with- 
out any danger of injury to the mouth ; for the extraction of 
roots comparatively loose, the thumb may be used as a 
fulcrum, by placing it upon the gum opposite the tooth or 
fang, or upon an adjoining tooth : it is in this way I mostly 
use it, and for that reason have given it the above title. 



EXCESSIVE HEMORRHAGE FROM EXTRACTION. 

It seldom happens, that the parts bleed more from the 
extraction of a tooth, than essential to reduce any existing 
inflammation ; it is even necessary, in some cases, to pro- 
mote it by warm applications. But with individuals of a 
hemorrhagic diathesis, instances of an alarming character 
have occurred, produced oftentimes by the slightest punc- 
ture ; when a known constitutional predisposition exists, 
the extraction of teeth should, if possible, be avoided. 

Various remedies have been suggested, and tried, to 
arrest hemorrhage ; the application of powerful styptics, 
cautery, wedges of cork, and lint, firmly pressed into the 
cavity ; but frequently without producing the required 
effect. 

In ordinary cases, kreosote, blue vitriol, pulv. alum, or 
the muriated tinct. of iron, will be found sufficient, and in 
protracted cases, the following expedient, suggested by my 



96 



DENTAL SURGERY. 



deceased parent, and practiced by him for many years, will 
prove most generally successful. 

Some years since, a young man residing in Philadelphia 
had a molar tooth extracted, after which the parts continued 
to bleed profusely for several days. Dr. Physic was called 
in, and administered all the known remedies without avail; 
he consulted my father, and together they visited the 
patient ; new remedies were suggested and tried, but still 
the bleeding continued ; while they were watching the 
patient, my father observed the man to contract his cheek, 
as if in the act of sucking, preparatory to ejecting the blood 
from his mouth ; it immediately occurred to him, that by 
propping his mouth open, the exciting cause would, in a 
measure, be removed, and the blood would soon coagulate; 
accordingly they placed a cork between his teeth, and with 
a bandage, passing under the chin and around the head, 
secured it. The result was that the bleeding ceased 
entirely in less than an hour. 

I have seen many severe cases, but have been able, 
upon every occasion, to succeed in arresting hemorrhage 
from extraction of teeth, by the above process, when 
resorted to. When local remedies prove insufficient, a 
constitutional treatment is the only alternative. The 
annexed case is one of some interest ; it is extracted from 
Robertson's Retrospect. 

[The patient, a boy about fourteen years of age, was 
found by Dr. Clay laboring under profuse hemorrhage in 
consequence of the extraction of the third molar tooth of 
the upper jaw ; the gum and cheek were very much 
lacerated. Various styptics had been applied : as N. of 



EXCESSIVE HEMORRHAGE FROM EXTRACTION. 97 

Myrrh, F. Ferri. Mur., Arg. Nitrat., &c, without stop- 
ping it. Dr. Clay used Matico, Secale, Ruspini's Styptic, 
and even the actual cautery, without the slightest benefit. 
Constitutional treatment alone remained, and, in consulta- 
tion, it was decided he should take the following mixture :] 

B. Plumb. Super. Acet, ... £ss. 

Acid. Acet. Dil., ... - gss. 

Syr. Rhead, §ss. 

Mist. 

Camp, %v. 

M. Ft. Mist. 

Sumat seger coch., magn., duo omni tertia hora. 

Thus five grains of the acetate of lead were given every 
three hours, or nearly so ; in addition to which pads, 
saturated with the liq. plumb, diacet. were applied to the 
bleeding surfaces with as correct a pressure as possible. 
Twenty-four hours passed under this treatment without 
improvement. 

At a second consultation with several gentlemen, in 
addition to whom, Mr. Bamber, a retired practitioner, and 
for many years medical attendant of the family, was 
present. It was agreed to persevere with the acetate of 
lead mixture until the following day, continuing also the 
pads of lint saturated with the matico. On the following 
morning, much to the satisfaction of all parties, the bleed- 
ing was checked ; this was the tenth day, and up to this 
time he had taken nearly a drachm of the acetate of lead. 

The boy began to complain of pain in the head and 
9* 



98 DENTAL SURGERY. 

stomach ; it was therefore evident that we could not 
proceed further with the acetate of lead ; and as the 
bowels had not been moved since the exhibition of 
it, it was determined to substitute the sulphate of soda, 
which the American physicians speak so highly of. 
A saturated solution was ordered, to the extent of half a 
wine glass every four hours, and in a very short time the 
bowels were acted upon. 

The bleeding was perfectly arrested from the tenth day, 
great care being taken, for some time, in removing the 
pads, and which were for several days moistened with the 
liq. plumbi. acetat. dil. I have omitted to mention the 
head was shaved when the constitutional treatment com- 
menced, and that evaporating lotions were kept constantly 
upon it. 

From the tenth day the boy very gradually recovered, 
though extremely reduced. He is now, December twenty- 
ninth, comparatively well, and the soft parts of his mouth 
perfectly healed. 



CHAPTER VI. 



EXOSTOSIS OF THE FANGS OF THE TEETH. 

Exostosis is an unnatural osseous formation, and is a 
disease common to all the bones. In the teeth it attacks 
the fangs only ; it generally commences at the point, some- 
times extending throughout the entire root ; but the most 
common appearance is of small knots, from the size of a 
pinhead to a cherry stone. 

This disease affects teeth that are, to all external appear- 
ances, entirely sound, and therefore cannot depend exclu- 
sively upon any diseased state of the tooth ; it is, doubtless, 
the result of inflammation in the fang, occasioned by an 
unhealthy condition of the gums. The peculiar appear- 
ance of this osseous product identifies it at once as to its 
character. When found on the teeth it presents an amber- 
like, yellowish color, more transparent and more porous 
than the healthy bone of the fangs. 

I recently extracted a molar tooth for a man, who had 
suffered for several weeks the most violent pain, accom- 
panied with great distress in his head. Upon a subsequent 
examination, the tooth, in every fang, was found affected 
with general exostosis of the root. After the extraction he 



100 DENTAL SURGERY. 

speedily recovered. Frequent cases have been noticed in 
which much suffering has arisen from this disease of the 
teeth, though I have known but few instances of it in 
teeth in other respects sound. 

The only remedy is a removal of the tooth or fang, 
necessity for which becomes evident from the general 
symptoms. 



THE DENUDATION OF THE ENAMEL. 

The origin and cause of this peculiar affection of the 
enamel of the teeth, remains, as yet, involved in doubt and 
speculative theories. It is a disease confined chiefly to the 
external surfaces of one or more teeth ; and sometimes, 
though very seldom, embraces the entire dental system. 
The peculiar characteristics by which it may be known 
from ordinary caries, are horizontal lines or grooves, on the 
exterior enamel of the incisors and cuspidati ; and a multi- 
plicity of small dot-like cavities, or indentations, which 
sometimes unite in forming one general decay, continuing 
frequently through the enamel, until it penetrates the 
bone. 

Another character of disease, which has been classed 
under the same head, is that of a black, opaque spot, 
extremely hard and highly polished in its appearance, 



THE DENUDATION OF THE ENAMEL. 101 

which is found on some teeth, remaining for years without 
any sensible increase. 

Mr. Hunter, who was the first to notice this affection, 
supposes it " to originate in the tooth itself, and not to de- 
pend on accident, way of life, constitution, or any particular 
management of the teeth." 

Mr. Bell acknowledges his inability to account for it, but 
thinks it " connected with the manner in which the enamel 
is deposited during its formation ; for it will be recollected," 
says he, " that it first covers the apex of the tooth, and 
gradually % invests the crown, by successive circular deposi- 
tions ; it is therefore not improbable, that from some tem- 
porary cause, acting during its deposition, certain circular 
portions may be more liable to mechanical abrasion, or 
other injury than the rest." 

Mr. Fox attributes it to some solvent power of the saliva. 

Dr. Harris denounces all the above theories, but does 
not favor us with his own opinion, in regard to the causes 
of its origin. 

For many years, before I was aware of Mr. Fox's theory, 
my own observation led me to suppose it attributable to the 
action of the saliva, or the mucous secretions of an unhealthy 
mouth, as ordinary caries, though the symmetrical order and 
peculiarity of location of its appearance, has always remained' 
unaccountable to me. 

It differs, however, from caries in its character and 
locality, as it is rarely found, except only upon the exter- 
nal surfaces of the teeth. 

A few weeks since, I was visited by a young girl of about 
seventeen years of age, whose superior central and lateral 



102 DENTAL SURGERY. 

incisores of the right side, were affected by a denudation of 
the enamel of those teeth in its apparently incipient stage ; 
the central tooth bore a deep horizontal groove upon its front 
surface, and the lateral tooth a combination of four small 
cavities. She stated to me, that when a child she received 
a blow on the corresponding deciduous teeth, and that the 
affected teeth wore the same appearance they now do, as 
long as she could remember. 

This case, if correctly stated to me, would appear in 
opposition to Mr. Fox's theory, and tend to confirm that 

offered by Mr. Bell, in view of the dependence of the per- 

# 

manent teeth upon the temporary ones. 

In the treatment of denudation, where the disease is 
only superficial, the enamel should be filed smooth and 
polished ; but if it has penetrated to the bone, or deeply 
into the enamel, the cavity should be filled as in caries. 



NECROSIS OF THE TEETH. 103 

NECROSIS OF THE TEETH. 

This condition of the teeth is analagous to that of the 
other bones of the system in its character, with the excep- 
tion, that it produces the entire death of the teeth ; but in 
the bones, by a process belonging to them only, the dis- 
eased part is thrown off, and gives place to a deposite of 
new bone. Necrosis produces a discoloration in the tooth 
by which it may be easily detected, and frequently affects 
teeth presenting no external evidences of disease. 

The causes that produce necrosis may be referred to sud- 
den blows, the excessive use of mercury, and to most of the 
exciting causes that lead to an unhealthy state of the gums. 
When this disease becomes fixed, no remedies will act on 
it ; the tooth is then an extraneous body, and liable to all 
the consequences of such ; but in its earlier stages, lancing 
of the gums and the administration of tonic washes will 
exercise a healthy tendency. After a time, when the tooth 
becomes a source of irritation, it should be removed to pre- 
vent any bad effects arising from it. 



104 DENTAL SURGERY. 

DISEASES OF THE GUMS. 

That a strong sympathy between the teeth and gums 
exist, cannot be denied, and that a majority, if not all, of 
the diseases of the teeth originate in an unhealthy state of 
the gums, may be equally admissible ; -it is to an excited 
condition of the gums, that we can refer many of the pains 
felt in teeth -perfectly sound, which go and return periodi- 
cally. Nervous irritation is doubtless the cause, and may 
be induced by cold, derangement of the stomach, and other 
remote causes. 

Waite says, " the affections of the stomach are perhaps 
more directly concerned with our subject than those of any 
other part of the human frame. 

"Accompanying the nausea, headache, and constitutional 
derangement, we have sympathetic pain extending to the 
gums, and even to the teeth. 

" Those sympathies furnish us with an explanation why, 
when the stomach is out of order, we have rheumatic 
affections of the jaws with disturbed nights ; why toothache 
is under such circumstances so liable to occur, and is so 
terrible ; why that gum, which before was firm and hard, 
becomes extremely sensitive, swells and suppurates ; why 
the constitutional languor and dejection are so excessive ; 
why palpitations of the heart, on motion, syncope and de- 
lirium, are also accompanying characteristics produced by 
swellings of the gum." 

Violent emotions of the mind have been supposed to 
exercise an effect on the teeth and gums. Mr. Waite, in 
his essay upon the gums, cites the case of a lady, " who 



PISEASES OF THE GUMS. 105 

was afflicted with great grief and anxiety ; the digestive 
organs became deranged to a very considerable extent, and 
great nervous excitement was roused in her constitution ; 
pain became suddenly fixed in the gums corresponding to 
two front teeth ; they dropped and became extremely 
loose." 

Another was that of " an English officer detained prisoner 
of war at Verdun, and who possessed very strong teeth and 
healthy gums, labored under all the symptoms of Nostalgia.* 
Although permitted to go out, he took his imprisonment so 
much to heart, that he never stirred from his room ; pain, in 
a similar manner to the case above named, centered itself 
in the gums ; the teeth loosened and were extracted. It 
was an inordinate action of the vessels of the gums, caused, 
in both instances, by the mind and body sympathizing, 
w T hich hastened the loss of these teeth." 

The diseases of the gums may be regarded as constitu- 
tional in some cases, and in others as arising from some 
immediate or exciting causes. 

Those diseases which are referred to constitutional 
causes, may be produced by some remote affections of the 
general system, or may be traced to hereditary predisposi- 
tion. In inflammatory fever the tongue, mouth and throat, 
exhibit characteristics of its particular stages, while the 
gum presents a debilitated condition, with a swollen and 
vascular appearance, and an increased arterial circulation. 
It has been asserted that the gum remains in a swollen 
condition during the prevalence of intermittent fever. 

Scurvy is remarkably apparent by the effects it produces 

* A vehement desire to visit ones native country. 
10 



106 DENTAL SURGERY. 

on the gums ; they contract and expose the neck of the 
teeth, and deepen into a morbidly unhealthy color, bleed 
easily, and discharge a very disagreeable matter. The 
disease continuing, the alveolar soon becomes destroyed by 
absorption, and the teeth eventually drop out. 

Those diseases arising from more immediate and exciting 
causes, depend principally upon the condition of the teeth. 
The sympathy between the gums and teeth require a 
healthy tone in the one to produce a corresponding action 
in the other ; if the gums labor under a scorbutic taint, the 
inflammation, extending to the investing membrane of the 
tooth, soon destroys its connection in the socket, and makes 
it sensitive to every touch, thus not only depriving it of its 
usefulness, but adding pain to the inefficiency of the organ. 

Abscesses in the alveolar cavity are frequent forms of 
disease. Matter collects in the cell of the socket, from 
some unhealthy action of the parts, and penetrating 
through the gum, discharges itself in that way, but leaves 
the socket a prey to the absorbents, by which it is soon 
destroyed. 

The most common character of disease in the gums is a 
flaccid and spongy appearance ; they become swollen, and 
bleed upon the slightest puncture ; " the apices, or points 
between the teeth, become congested with blood, and an 
exudation of a viscid fluid takes place, which, if allowed 
to remain for any time in contact with the teeth, corrodes 
the enamel, and they become black and unseemly." This 
form of disease is the result of decayed fangs, or teeth 
allowed to remain in a state of irritation, by accumulations 
of calcareous matter, and by a disordered state of the 



DISEASES OF THE GUMS. 107 

stomach. Neglect in a proper regard to cleanliness of the 
mouth, and the use of certain kinds of dentifrice and solu- 
tions, are also exciting causes to it. 

In treating this disease of the gums we must be governed 
by the causes that have produced it ; if any decayed roots 
still remain in the mouth, they should at once be extracted, 
and any amount of tartar that may be deposited upon the 
necks of the teeth it is necessary to remove. It cannot be 
expected, if much absorption of the alveolar has taken 
place, and the teeth are loose, that they will ever regain 
their firmness, but a healthy tone may be acquired by 
which they can be retained longer in the mouth than if 
allowed to remain unrelieved. 

As the existence of irregular teeth will frequently be 
found attended with the condition of the gums alluded to, 
in order to assist in the removal of any disadvantage they 
may occasion, proper remedies should be resorted to for cor- 
recting their irregularity. Mr. Koecker recommends the 
removal of any remaining molar in the upper jaw that has 
no antagonist. Such a course I regard as altogether need- 
less ; it is very seldom that any disadvantage will arise 
from it to any of the remaining teeth, and the tooth may 
some time subsequently prove valuable as an auxiliary in 
another operation. 

A free bleeding of the gums is attended with benefit, 
and should be promoted by the application of warm water 
after scaling the teeth, and by frequent brushings, at least 
three times a day, which should be continued until the 
gums begin to assume a healthy condition. The applica- 
tion of leeches, when the gums are much swollen, have 
been very generally used to great advantage. 



108 



DENTAL SURGERY. 



The following wash for the mouth will be found very 
serviceable to give tone and vigor to the gums, and should 
be used from three to six times per day, according to the 
necessities of the case. 

B. Alumen, Pulv. - - - - gij. 

Tinct Opii, ----- g S s. 

Tinct Myrrhi, gss. 

Aqua, - - - - - - §yj. 

Misce. 

A decoction of Spanish oak bark will assist in imparting 
health to the gums ; or a tincture of Krameria ; this may 
also be used in the form of a decoction. Either of these 
preparations may be substituted for the alum and water in 
the first prescription, or they may be used entirely alone. 
If the gums continue sore, and bleed easily, the compound 
preparation should be preferred ; but if only tender to the 
touch, the simple decoctions will suffice. Sometimes a 
little pulverized orris root is added to give flavor to any 
particular wash. Mr. Fox recommends, upon the failure 
of the usual remedies, and the gums continue to bleed, to 
touch their edges with lunar caustic. The most effectual 
mode of applying it, is, when practicable, by touching the 
parts with the roll. When this plan is inconvenient, a 
solution may be made by dissolving two drachms in one 
ounce of water. This treatment is calculated to change 
the character of the disease, from which a new and healthy 
action may be produced. 

I was recently consulted by a young lady, who had been 



DISEASES OF THE GUMS. v 109 



V 



afflicted for sometime with a " preternatural prurient growth 
of the gums," to such an extent as to completely invest to 
the cutting edges, all the teeth of both jaws ; the gum was 
slit longitudinally with the spaces between the teeth, and 
lay as flaps upon the surface. After excising the gums even 
with the margin of the crowns of her teeth, I directed the 
wash prescribed on the foregoing page. Upon her second 
visit I extracted the right eye-tooth, which was crowded 
from its place, and with the enamel decayed off entirely 
from the front surface. I also removed the tartar from her 
teeth, which was in large quantities, and gave her a solu- 
tion of nine grains of lunar caustic dissolved in one ounce of 
water. This treatment had a beneficial effect ; and by sub- 
sequently using the brush and dentifrice, a healthy condition 
was soon obtained and preserved. I had forgotten to 
mention that I placed her on a low diet, and kept the 
bowels open with gentle cathartics. 



10* 



CHAPTER VII. 



PREPARATION OF THE MOUTH PREVIOUS TO 
THE INSERTION OF ARTIFICIAL TEETH. 

The importance of an entire health in the gums, prepara- 
tory to the adjustment of an artificial process to the mouth, 
must be evident to every dental surgeon. 

If disease exist, the remedies already recommended 
should be resorted to, and persisted in, until a healthy tone 
is produced, for without it, nothing less than future bad 
consequences are to be apprehended ; the presence of 
decayed fangs, with their attending results, should be 
avoided ; and teeth that may be in any way susceptible 
of dental skill should receive such attention and care 
as they need, and if past relief, they should be at once 
removed. 

Such is our advice, as a general maxim, but it is most 
frequently the case, that the labors of the dentist are limited 
to the circumstances or parsimony of his patients, and he is 
required to perform only a specific duty ; one rule, how- 
ever, should be invariable with him, and from which no 
persuasions should induce him to depart. 



PREPARATION OF THE MOUTH. Ill 

I refer to the insertion of teeth on plates over a number 
of diseased fangs ; the retention of three or four in a sound, 
healthy state may not be objectionable, provided their 
natural cavities are filled as in caries ; but it is often that 
the patient insists upon keeping a regiment of worthless 
stumps, to defend the gum from falling in, or to avoid a 
little pain, heedless of the greater amount contracted in 
preparing those fangs for the proper fitting of the teeth. 
A case occurred to me of such a character a short time 
since. A gentleman called on me to furnish him with an 
upper set, with the exception of two teeth that were per- 
fectly sound. I at once recommended the extraction of 
a number of roots remaining in the jaw, he declined having 
them out ; I refused to make his teeth ; he returned to me 
a few days subsequently, and insisted with much warmth, 
urging, as an objection, that his nerves were in a diseased 
state, and he could not possibly bear their extraction ; I 
reluctantly consented, and made the teeth for him : he wore 
them about six weeks without much inconvenience ; at the 
end of that time, the gum, already in an excited state, began 
to swell and envelope the whole exposed surface of the 
roots, so" that the plate and teeth, by their pressure, gave 
him a great deal of pain and inconvenience, and finally 
obliged him to lay them aside for a while, until the inflam- 
mation should subside ; a repetition of the cause may bring 
on a return of the difficulty, and it is quite probable he will 
be unable to receive any benefit from them, or even be able 
to wear them with any degree of comfort. 

After the extraction of roots of teeth, it is necessary to 
delay a sufficient length of time, for the recession of the 



112 . DENTAL SURGERY. 

gums by the absorption of the alveolar, before the artificial 
process is inserted, to be determined according to the 
number and position of the roots extracted ; if, for example, 
the fangs of the incisores have been removed, leaving the 
eye-teeth in the mouth, a delay of about six or eight weeks 
is necessary ; if only two contiguous teeth are taken out, 
from two to three weeks are sufficient, and a single tooth 
may be replaced as soon as the gum closes. The loss of 
the entire denture of either jaw will require from ten to 
twelve months to complete the process of absorption. 

When only one or two roots are extracted, the absorption 
of the alveolar is not as complete as when a greater number 
are taken out, and hence the cause why they may be sooner 
replaced. 

If necessity exists for a greater haste than the occasion 
would justify for the insertion of the artificial teeth, some 
allowance may be made by causing the base of the teeth to 
press hard against the gum. 

I have known teeth inserted w T hen even the contiguous 
ones were unworthy of retention, and so dilapidated as to 
require extraction in a few months ; in many such cases the 
dentist has promised to accurately fit teeth to supply the 
deficiencies as they occur, heedless of the impracticability 
of doing justice to the patient; as the plate, to be complete, 
should accurately fit the remaining teeth, and as the absorp- 
tion of the gum is not circumscribed by the limits of the 
tooth only, but covering two or three times its area, so 
when a tooth is extracted after the adjustment of the artifi- 
cial apparatus, it is impossible to fully supply the deficiencies 
of the gums, and a large cavity is frequently left under the 



f 



PREPARATION OF THE MOUTH. 116 

plate, as a place of deposite for extraneous matter, noxious 
to the patient and hurtful to the gums. 

After the extraction of a number of roots, and the gums 
have entirely healed, I sometimes make a temporary set of 
teeth to be worn until the jaws are fit for the recep- 
tion of permanent ones ; this plan is somewhat pre- 
judicial to the interests of the operator, but less so than the 
too hasty insertion of a permanent set. 

The objections to temporary teeth, consist in the disad- 
vantage existing against their proper and comfortable 
application to the gums ; and with the fact that they are 
designed for only a temporary purpose, the dentist is not 
warranted in bestowing labor sufficient to make them as 
neat and natural in their appearance as might be desired ; 
therefore, if he can avoid it, his own reputation would be 
enhanced by omitting them altogether. 









114 DENTAL SURGERY. 



ENGRAFTING TEETH. 

This mode of inserting artificial teeth is of all others 
the most simple, and, under proper circumstances, the most 
desirable. The propriety of its adoption should be deter- 
mined by the condition of the fang, both as regards its 
health and permanency. If the root is in a state of 
inflammation, a proper remedial course should be resorted 
to, and every indication removed before the operation is 
attempted ; after which, if the root is sufficiently firm and 
solid, by an accurate mechanical adaptation, the artificial 
crown may be inserted with some prospect of usefulness 
and durability ; but, on the other hand, if, as is frequently 
the case, no regard is paid to the condition of the fang or 
the gums, failure of success will be the inevitable result. 

Teeth inserted in this way, vary in their duration from 
two or three to ten, twelve, or even fifteen years, depend- 
ing upon the health of the gums, and the manner of inser- 
tion. 

The incisores and cuspidati are the only teeth capable 
of being engrafted upon, as the fangs of those teeth have 
their natural cavities in the centre, and but a single fang ; 
whereas the other teeth have two or more fangs, frequently 
diverging, and, independent of other objections, are so 
situated in the mouth as to render the inconvenience of 
access to them a difficulty in the accurate insertion of arti- 
ficial crowns. 

To avoid any danger of inflammation from the pressure 
of a pivot, upon the the first insertion of a tooth, a tempo- 



ENGRAFTING TEETH. 115 

rary one should be used, to be supplanted by a larger one 
two or three weeks subsequently ; by this means it can be 
easily removed upon the first symptoms. 

Sometimes, to avoid a swelling of the gums consequent 
upon inflammation of the fang, I have inserted a fine tube 
through the pivot and posterior side of the tooth, by which 
an egress is formed for suppurating matter. Another 
method, I believe also recommended by some one ante- 
cedent,* is to cut a groove or gutter in the pivot, and a 
transverse one on the tooth leading from it, or upon the 
exposed surface of the fang. 

The importance of a constitutional treatment, before 
adjusting an artificial tooth on a pivot, is seldom duly con- 
sidered, and hence the evil consequences that so frequently 
arise from the insertion of teeth in this way. The mode of 
treatment suggested by Mr. Waite may seem rather prolix, 
but when the constitutional sympathy with the gums, and 
their influence upon the teeth, are understood, the import- 
ance of a thorough treatment will be more fully appreci- 
ated. He sa}^s : 

" It is a matter of the highest importance, when the 
gums assume tints indicative of an irritable habit of body, 
that, previously to teeth being pivoted, the constitution 
should be well prepared for the operation ; that, at the time 
of performing it, all sensibility in the root should be dead- 
ened, and the gum corresponding to the extremity of the 
root freely lanced. This acts with a double effect; it first 
produces a discharge of blood, and, secondly, forms a 

counter irritation. 

* Dr. Harris. 



116 DENTAL SURGERY. 

" When inflammation is much to be apprehended, the 
following prescription ought to be had recourse to : 

R. Pil. Hyd. Subm. Comp. - - gr. iij. 

Ext. Col. Comp. - - - - gr. vii. 

M. Pil. ij. 

Hora. Somni Sumendse. 

R. Magn. Sulphat, - - - - gss. 

Inf. Sennse, ----- jiss. 

M. 

To be taken in the morning. 



a 



On the following day, continuing spare diet, let a 
Seidlitz powder be taken, and at night take the following 
pill: 

R. Pil. Hyd. Subm. Comp. - - - gr. j. 
Ext. Col. Comp. - - - - gr. iv. 
M. Pil. i. 

In the morning let a Seidlitz be taken, and the operation 
may then be performed." 






PROCESS OF ENGRAFTING TEETH. 117 

PROCESS OF ENGRAFTING TEETH. 

To prepare a fang for the reception of an artificial 
crown, it should be cut in the form of a semi-circular 
groove, even with the posterior and anterior margins of the 
gum. If a portion of the crown of the original tooth 
remains, it should be partly separated with a thin file, 
and then excised with a pair of cutting forceps ; if 
only small spiculas, or a very much decayed portion, 
is in the way, the semi-severing with the file will be 
unnecessary, the object of which is to avoid the sudden 
jar apt to be occasioned by cutting away solid por- 
tions with the nippers. The neglect of this prepara- 
tory process, when necessary, may be productive of 
inflammation in the excision of a solid fang, or may 
endanger a splitting of it. To complete the external pre- 
paration of the root, a file should be used, of a half-round 
shape, regular (not tapering) and finely cut. 

Upon the opening of the natural cavity, the sensibility of 
the nerve will frequently interfere with the operation, to 
obviate which, as also to prevent future pain from it, the 
destruction of that portion of the nerve remaining in the 
fang becomes necessary. 

Some operators recommend the insertion of a fine needle 
in the cavity, twisted round, and suddenly withdrawn. 
This process, I think, must require frequent applications to 
accomplish the object, whereas the employment of a 
heated instrument generally succeeds the first time. The 
objections to a hot needle, arises more from the dread 
11 



118 DENTAL SURGERY. 

excited by a blazing lamp than the actual pain of the ope- 
ration. This may be obviated by using a lamp* similar to 
one I have constructed for the purpose. 

The insertion of a fine probe will determine if all sensi- 
bility is removed, after which, the root is ready for boring ; 
which is to be done by enlarging the . opening with a 
brooch, and drilling to the depth of two or three eighths of 
an inch with a small size drill for sound roots ; decayed 
ones require larger holes, in. order to remove as much as 
possible of the carious portion, obtaining a healthy part for 
the walls of the cavity. 

Many operators use the " drill and bow," and others the 
" hand-drill ;" the latter I consider altogether to be pre- 
ferred ; it is less formidable, and with little practice, 
may be used to a better advantage than the former ; there 
is also less danger in the use of it. The direction given 
to the hole should be in accordance with the natural 
cavity. Sometimes a little deviation becomes necessary to 
correct a previous irregularity of the tooth ; in doing which, 
care should be exercised to avoid crossing the fang, and 

* This lamp may be made of brass or tin ; the former is preferable, 
both as regards finish and convenience of arrangement. A cylindrical 
box, of about three inches high and one and a half in diameter, should 
be furnished with a small spirit-lamp upon the lower part of the inside. 
A tube is inserted about midway and soldered to the box or cylinder ; 
this tube is separated upon the inside of the case, immediately over the 
blaze of the lamp, so as to heat the needle, which is secured to an 
instrument accurately fitting the tube. A spring is attached, by which 
the needle, when heated, can be thrown through the tube into the 
nervous cavity. The end of the tube is made very small, to fit the 
orifice of the cavity, and a check given to the needle, to prevent too 
deep an entrance. 



PROCESS OF ENGRAFTING TEETH. 119 

penetrating it through the side to the alveoli. Some 
allowance can be given in the form of the pivot. 

A temporary pivot of soft wood should be used in fitting 
the tooth, and when finished, ready for insertion, a perma- 
nent one may be made from well-seasoned hickory. The 
length of the pivot can be ascertained by wrapping raw 
cotton on the end of a drill and entering it into the 
cavity. 

Before finally securing the tooth, it will be necessary to 
cut away any portion that may strike the opposite teeth 
upon the occlusion of the jaws, so that the bearing may be 
upon the natural and not the artificial teeth, otherwise they 
will be liable to be loosened or knocked out. 

In the fastening of the tooth, no more force should be 
applied than just sufficient to allow the entrance of the 
pivot by the pressure of the hand, with a forked instru- 
ment (made of ivory) resting upon the cutting edge of the* 
tooth. A hammer should never be used, for by it the 
tooth or fang may be broken, and the sudden concussion is 
likely to produce inflammation of the root or alveoli. 

In the choice of a material for pivoting, some practi- 
tioners recommend gold, silver, and platina, but wood is 
unquestionably preferable to any metal ; it will fit more 
accurately the holes in the fang and tooth, and by its 
swelling becomes very firm and solid. When gold or 
silver are used, they should be made of half-round wire, 
with the flat sides doubled together, and soldered into the 
tooth at the bite. A sliver of wood should be placed 
between the legs of the pivot, to separate them by its 
swelling. 



120 DENTAL SURGERY. 

I have been surprised, in reading the works of cele- 
brated operators, to observe the extremes into which they 
have fallen, in the different materials recommended by 
them for fastening pivot-teeth. Mr. Koecker opposes the 
use of pivots of wood, and directs that they be made of 
fine gold or platina. He savs that wcod " remains per- 
fectly firm in the roots for many years," and that the root 
finally " is either split by the great swelling of the wood in 
the cavity, or nearly destroyed by its rapid decay." The fact 
that teeth inserted on pivots of wood, remain firm for such a 
length of time, is no objection ; the swelling of the pivot 
takes place immediately after its insertion, when the fang is 
able to bear the pressure ; any subsequent decay of the root 
is attended with a like condition of the pivot, which be- 
comes, in consequence, unable to exert any pressure upon 
the walls of the cavity ; further, he says, that he " inserts 
a tooth in such a manner, that the patient should be capable, 
after receiving the necessary instructions, to remove it and 
replace it at pleasure." The objections to this practice are 
manifold ; the constant attrition upon the sides of the 
pivot hole, I have found, when such a plan has been 
pursued, has worn the cavity to two or three times its 
original size, and as no possible advantage can arise from 
it, is certainly to be deprecated. 

Dr. Harris recommends " a delay of from four to eight 
days after the root is prepared before inserting the tooth;" 
as an objection would be generally made to remain so long 
a time without a tooth, I usually, when inflammation is to 
be apprehended, fasten the tooth loosely, renewing the 
pivot in two or three weeks. 



TOOTH POWDERS. 121 

TOOTH POWDERS. 

The following formulas of dentifrice will afford agreea- 
ble and useful compositions, without producing any injury 
to the teeth upon which they may be employed ; the appli- 
cation of paste made with honey or sugar is objectionable, 
but, notwithstanding, many persons insist upon using it; I 
have therefore given a recipe to make it by.* 

DENTIFRICE, NO. 1. 

R. Prepared Chalk, 6 ounces. 

Pulv. Orris Root, - - - - 2 " 
Pulv. Gum Myrrh, - - - \ " 

Color with rose pink. 

DENTIFRICE, NO. 2. 

B. Cuttle Fish Bone, 10 ounces. 

Prepared Chalk, - - - - 12 " 
Color with rose pink. 

Flavor with a few drops of rose and bergamot. 

DENTIFRICE, NO. 3. 



R. Prepared Chalk, - 


- 


8 ounces 


Charcoal, ■ 




- 2 " 


'; " Myrrh, - 


- 


i " 

4 



* The writer has reserved for his private use, only, from among all 
the different receipts belonging to the profession, that of making the den- 
tifrice which he generally uses. 
11* 



122 DENTAL SURGERY. 



DENTIFRICE, NO. 4. 



B. Pulv. Charcoal, 


- 


1 ounce. 


" Red Bark, - 




i 


" Gum Myrrh, - 


- 


1 


And perfume. 







Tooth powders should be passed through a fine bolting- 
cloth sieve, after being thoroughly incorporated. 



ORRIS TOOTH PASTE. 

R. Purified Honey, 1 gallon. 

Pulv. Orris Root. - - - 2 pounds. 

Prepared Chalk, 2 " 

Rose Pink, 2 " 

Oil Teaberry, \ drachm. 

Alcohol, 1 ounce. 

Olive Oil, - - ... l « 

This paste will be found an agreeable and pleasant den- 
tifrice for those who prefer it in this form. 



PART SECOND. 



MECHANICAL DENTISTRY. 



CHAPTEE I. 

This branch of the dental art has increased in import- 
ance and usefulness, within a few years, far beyond the 
expectations of any one. The introduction of a material 
for the composition of artificial teeth, incorruptible, and 
possessing the qualities so essential to their purpose, has 
opened a field for the skill and ingenuity of the artizan, 
unknown in the primary condition of the art. 

No opportunity better exists for an effort of mechanical 
taste and ingenuity, than the manufacture and adjustment 
of porcelain teeth to the proper performance of their 
required functions. 

The unceasing and energetic labors of the American 
dentist, have enabled him, by persevering experiments 
upon foreign invention, and by the exercise of his own 



126 DENTAL SURGERY. 

skill, to bring the production of artificial teeth to that per- 
fection, which thirty years ago would have been de- 
nounced as impossible. 

To rival nature itself, in point of symmetry'and beauty, 
with a set of artificial organs, subservient to all the pur- 
poses of the natural ones, and comfortable to the wearer, 
would have seemed, to any one, the supremacy of folly 
and romance, but which is, in reality, now almost the 
daily performance of the skilful operator. 

The French dentists were the first to introduce minerals 
as a component of artificial teeth ; but, although every 
encouragement was offered to them by the medical socie- 
ties of France, their progress to perfection was with a 
tardy pace. Their teeth being composed almost entirely 
of clay, were very opaque, too highly and unnaturally 
colored, and destitute of any natural form. In those now 
made in this country, a strict regard to color, form and 
translucency is observed, and with a success unerring, 
they may be justly entitled the " ne plus ultra" of artificial 
teeth. 

The material used before the introduction of minerals, 
was to be found in the teeth of the Hippopotamus, or the 
tusks of the Elephant ; teeth of cows, sheep, and human 
teeth, inserted artificially, or transplanted from one to 
another mouth. The latter practice has long become 
obsolete, and probably never was carried to any great 
extent. Mr. Hunter has advocated it with more confidence 
than any other writer on the subject. He has asserted that 
he has known " dead teeth to grow when placed in a 
foreign socket." 



MECHANICAL DENTISTRY. 127 

Without wishing to impugn the candor of the respecta- 
ble gentleman, and, to say the best of it, his credibility 
must have been easily operated on, or his judgment 
blinded to the real consequences of the operation. 

A possibility of reunion could only exist in the extrac- 
tion of a tooth, and its immediate replacement in the 
socket from which it was taken, while the mouths of the 
circumjacent vessels are open, and before a sufficient time 
should transpire to allow them to heal ; even then the 
prospect of success is very doubtful. 

The transposition of a tooth, from one socket to another, 
would be attended w r ith a thousand chances to one against 
any assimilation of . size or shape, subjecting the patient to 
much suffering and inconvenience, for a mere phantom or 
speculative hope. The practice is, under every circum- 
stance, an unsafe one, and not based upon any principle of 
nature or art ; it is the application of an extraneous body, 
with a design of resuscitation and union with living parts, 
and no certainty of its proper adaptation to be ascer- 
tained. 

As occasional preferences may be found for animal teeth, 
or some circumstances may require their use, I have 
thought proper to casually refer to the mode of setting 
teeth of such selections. 



128 DENTAL SURGERY. 



TEETH MADE OF THE TUSKS OF THE ELE- 
PHANT, OR TEETH OF THE HIPPOPOTAMUS. 

This material possesses more objection than any other 
animal matter used for the purpose ; it is porous, readily 
absorbs the saliva, and becomes decomposed in a very 
short time, by which it is discolored, and rendered highly 
offensive to the patient. It has been used chiefly for sets 
of teeth to be sustained by atmospheric pressure. In some 
cases the front teeth have been supplied by natural ones, 
the bicuspidati and molares being carved in the ivory. 

In selecting for the purpose, a piece should be chosen 
with a curve corresponding with the arch of the jaw, and 
with an enamelled exterior ; it is then to be sawed out, in 
length and size, according to the mouth for which it is 
intended ; and the base excavated with small gouges, chisels, 
&c, until it fits the gum accurately. In order to ascertain 
the prominences of the gums, the surface of the plaster 
mould should be coated with chrome yellow, or other col- 
oring matter, put on with a hair pencil, from which a cor- 
responding impress may be obtained, serving as a guide to 
excavate by. Care is necessary, to avoid making the 
excavation too large ; unless it bind a little upon the exte- 
rior of the gum, the suction will not be adequate to sustain 
it in the mouth. After the block is properly fitted, the 
teeth should be laid out and separated with a saw, and 
finally carved into a natural form. The enamel should be 
polished with fine sand on coarse muslin. 



TEETH MADE FROM THOSE OF COWS AND SHEEP. 129 

If there are teeth in the mouth capable of supporting 
the artificial ones, clasps may be riveted upon the process 
and fitted to them. 



TEETH MADE FROM THOSE OF COWS AND 

SHEEP. 

The teeth of old cattle only are fit for dental purposes, as 
by age, the natural cavity becomes filled up with a deposite 
of bone ; the great disproportion between them and the 
human tooth, sometimes require more than one half of the 
crown to be cut away, to make it of the necessary size and 
shape ; and, therefore, in the teeth of young cows, where 
the nervous cavity is large, the tooth would be left a mere 
shell, without sufficient substance to support it in fastening 
it to the plate, or on the pivot. 

In the selection of them, they should be held to the 
sun, and if a red appearance, indicating blood, is appa- 
rent about the natural cavity of the crown of the tooth, 
they should be discarded as unfit for use ; a more cer- 
tain method is to saw off the crowns from the fang. 
These teeth are of ephemeral durability, generally last- 
ing not more than two or three years, though sometimes 
they may remain in tolerable condition double that length of 
time; their milky whiteness is a great objection, and would 
12 



130 DENTAL SURGERY. 

be insurmountable, were it not the case, that they are so 
readily acted upon by the salivary secretions, and soon 
change their color, generally approximating to that of the 
contiguous natural teeth, and gradually deepening by the 
process of decomposition that commences with their inser- 
tion, until they become so much decayed as to be no longer 
capable of being retained in the mouth. 

These teeth may be secured by pivots, or placed on me- 
tallic plates. When they are to be engrafted, they should 
be cut with a file to the necessary width, taking an equal 
amount from each side, the edges rounded smoothly, 
and the crown sawed off according to the required length ; 
it is then fitted to the fang in the mouth. When the 
hole is bored in the root, the artificial tooth is pressed into 
its assigned position with a small piece of wax placed on 
the base, by which a protuberance is obtained, serving as a 
guide to centre the hole by, to be bored in the tooth. The 
pivot should be inserted before any portion of the posterior 
part is cut away, in order to retain the strength of it, neces- 
sary in the forcing in of the pivot ; afterwards, it may be 
filed away to clear the opposite teeth, and to correspond in 
length with the adjoining ones. 

To plate these teeth, the mode described in setting 
human teeth should be pursued, after reducing them to 
the proper form and size. 

Sheep teeth are used to supply the deficiencies of lateral 
incisores of the upper jaw, and the incisores of the lower 
jaw, their size corresponding better with the natural ones. 



HUMAN TEETH. 131 



HUMAN TEETH. 



Human teeth, artificially inserted, maintain a preference 
to all other animal substitutes, being less liable to decay, 
and corresponding better in form and color ; some objection 
exists among persons unacquainted with their physiological 
character, believing them frequently to be a source of con- 
tagion ; the process they undergo in cleaning will effectually 
obviate any difficulty on that score ; besides, being a dead 
body, they cannot be capable of retaining in the slightest 
degree any noxious principle. 

These teeth may be inserted upon a root, by means of 
the pivot, or on metallic plates with clasps to support them. 
The usual method of making the plates, is to bend a piece 
of half-round wire to fit the inequalities of the mouth, con- 
tinuing the ends around the teeth that are intended to hold 
them; a notch is to be filed, of the width of the space or 
spaces to be supplied, half-way into the wire, to receive the 
edge of a strip of flat plate, about the eighth of an inch 
wide, which is then soldered to it, being held together by 
fine iron wire or clamps. 

The teeth are cut about half-way through from the pos- 
terior side with a thin saw, and thus secured on the plate, 
two small holes are bored through the teeth and plate, 
through which rivets are fastened. 

This mode of inserting teeth requires considerable prac- 
tice, to be able to give them the proper position in making 
the saw curf, as that determines, particularly when there 
are more than one tooth upon the same plate, the position 
of the tooth in every respect. 



132 DENTAL SURGERY. 

When a human tooth is to be engrafted on the root, the 
natural cavity should be taken as the direction for the pivot- 
hole, and the process continued as described in the insertion 
of animal teeth. 



PORCELAIN TEETH. 

Porcelain is, without exception, in every respect pre- 
ferable to any thing ever used in the construction of arti- 
ficial teeth ; being composed chiefly of minerals, it will 
withstand all action from the saliva, and is not affected by 
any thing received in the mouth ; it therefore may be kept 
clean and of a healthy tendency ; the color is permanent, 
and its flinty hardness enables it to sustain any amount of 
wear without injury. 

Porcelain, when prepared and fit for use, is plastic and 
capable of being moulded or carved into any required form. 
Originally, teeth made of this material were colored with the 
baser metals, such as lead, iron and copper, in the form of 
an oxide ; but the finer metals have superseded them to a 
better purpose. 

Clay formerly entered largely in the composition of por- 
celain teeth ; but owing to the opacity it gives, is now used 
in very minute proportions. Flint glass was a principle 
ingredient in the enamel, combined with silex ; generally, 



PORCELAIN TEETH. 133 

from a want of proper assimilation, teeth so enamelled were 
constantly liable to being crazed or broken in the process 
of soldering ; now glass is employed only as a flux to fell- 
spar in very small quantities. 

A composition, for the manufacturing of porcelain teeth, 
is made, possessing all the natural and important qualifica- 
tions, translucent, and capable of withstanding any required 
amount of heat, and sudden transitions of heat and cold ; 
in color and form to suit every demand, and with a proper 
regard to the characteristics of nature, are moulded or 
carved of every desirable shape and size. 



12 1 



CHAPTEE II 



THE HISTORY AND COMPOSITION OF 
PORCELAIN. 

The art of making porcelain, appears by history to have 
been known first in Egypt, from thence it was carried into 
Greece, and then to Rome. In Persia, also, there was a 
species of porcelain made. 

In China it was carried to some perfection ; from the 
earliest historical knowledge of that country, porcelain was 
made probably equal to what it has been since. " And to 
have acquired such skill, evidences that long anterior to 
the era whence we obtain the earliest information, the 
Chinese must have practised and been engaged in the im- 
provement of the art." 

For a length of time, the art, as practised in China, was 
considered a great mystery ; but the secret was discovered 
by F. D. Entricolles, who visited the manufactories, and 
made himself acquainted, not only with the materials used, 
but with the whole process, and communicated the infor- 
mation in a letter which was addressed to T. Orry, and 
published by him in France. 



THE HISTORY AND COMPOSITION OF PORCELAIN. 135 

Etruria was the first place where the Romans attained any 
eminence in the manufacturing of porcelain. 

In the latter part of the seventeenth century, this ware 
was first introduced in England ; but it was not until the 
year 1760, that any material improvements took place. At 
that time, Mr. Josias Wedgewood, so famed for the compo- 
sition, of which mortars are used, still bearing his name, 
added, by his inventions and discoveries, much valuable 
information in the formation of this and other similar wares. 

" Continuing his experiments, he afterwards invented 
several other species of porcelain ; among which were, first, 
Terra Cota, resembling porphyry, granite, Egyptian marble, 
and other beautiful stones of this silecious or crystalline 
order ; second, Basaltes, or black ware ; third, white por- 
celain biscuit ; fourth, Jasper, a white porcelain of exqui- 
site beauty ; fifth, Bamboo, or cane-colored porcelain ; 
sixth, porcelain biscuit, remarkable for great hardness, 
little inferior to agate." 

From England porcelain was introduced into France, 
where the idea of making teeth of this substance first 
originated. " M. Audibran, says,* that Fauchard, as early 
as the year 1728, recommended the manufacture of incorrup- 
tible teeth. And in 1776 they were made by Duchateau, 
an apothecary of St. Germain." They continued to be 
made from that time by the French, with occasional im- 
provements, until their introduction in the United States, 
where they were speedily brought to the perfection of the 
present day, notwithstanding the superior advantages pos- 
sessed by the French dentist. 

* Harris's Dental Surgery, p. 18. 



136 DENTAL SURGERY. 

The composition of which porcelain is made is of two 
distinct characters, the translucent and the opaque ; the 
former is composed entirely of minerals, and the latter 
chiefly of earths. 

The translucent material is best adapted to teeth which 
can be moulded, and the opaque to blocks or sections that 
require to be carved. 

The porcelain tooth is composed of a paste, which con- 
stitutes the body of the teeth, corresponding with the bone 
of the natural teeth, and the enamel or glazing covering 
the whole surface of the tooth except the posterior side 
and the base: that part which rests upon the metal, in 
plate teeth, and upon the fang in pivot teeth. 

A proper degree of assimilation of colors in the body 
and enamel is essential, particularly in translucent teeth, 
in order to produce distinct shades and tints. Some 
manufacturers make the body yellow, in imitation of the 
natural bone, which has a tendency to present a dead 
white appearance in the mouth, plainly visible by an arti- 
ficial light. I prefer the darker grades of color. The 
blue gives a much better effect, by its absorption of light, 
and also produces a more lively appearance, in character 
with the human tooth. 

The enamel requires a great many varieties of color to 
match the various teeth met with in the mouth. Each 
tooth should possess at least two different colors on its 
exterior surface, a yellow, covering from a half to one-third 
of the front/from the base of the tooth, and the blue, inter- 
mingled with the yellow, to the cutting edges. 

In preparing the material for the body of the tooth, after 



THE HISTORY AND COMPOSITION OF PORCELAIN. 137 

carefully selecting and mixing, it should be ground in a 
hard Wedgewood mortar, occupying about twelve hours to 
each pound of the material. It should be kept covered 
and free from dust, and, to facilitate the operation, may be 
assisted by means of a lever resting on the shaft of the 
pestle, a simple upright stick, halved into the handle of 
the pestle on one end and placed in a socket on the under 
side of the lever. The shaft may be about three feet long 
and the beam six feet ; not more than five pounds can be 
ground with ease in a twelve-inch mortar. I seldom grind 
more than three. 

To fully understand the various effects of the compo- 
nents of porcelain, it is necessary for the student to study 
their peculiar characteristics — their formation and analyti- 
cal results — by which he may be governed in the com- 
pounding of them with a certainty and effect, so essential 
in the successful prosecution of the art. 

The following are the principle ingredients now used in 
the making of porcelain : 

Fell- spar, j 

Kaolin, } Forming the paste or composition of the body. 

Silex, J 

Fell-spar, 

Silex, } Forming the enamel of the tooth. 

Flint glass, 



138 DENTAL SURGERY. 



FELL-SPAR. 



Few minerals are more widely diffused than this. It 
forms a necessary part of most primitive and many second- 
ary rocks. Its colors are various, but it has a peculiar 
lustre, an'd a foliated structure, by which it is easy to dis- 
tinguish it from other minerals. 

It has several varieties, which all agree in respect to 
structure and peculiarity of lustre. 

Fell-spar, intermixed with small quantities of other 
minerals, forms entire mountains in several parts of the 
globe. 

Fell-spar, with garnets, forms a mountain in the west of 
Scotland. In Liberia the common foliated spar forms 
entire mountains. In the north of Scotland there are 
mountains and large strata of the same mineral. 
f The common fell-spar, or that species which abounds 
most plentifully, is of an opaque, white color, sometimes 
freely intermixed with quartz, of a foliated structure, 
capable of being split in two different directions, and of a 
shining lustre, is very hard, and will scratch glass. When 
fused, it forms a transparent glass or enamel. 

The greater part of fell-spar used in the middle 
states, is obtained from the neighborhood of Wilmington, 
Del. The quarry known as " Cook's quarry," has fur- 
nished considerable, and of a superior quality. 

In the preparation of this mineral for dental purposes, it 
should be carefully selected from the impurity with which 
it abounds, which is done by breaking it to pieces with a 



FELL-SPAR. 139 

hammer, and calcining, (by heating red hot and suddenly 
immersing in water;) it may then easily be reduced to 
powder. To further reduce it as fine as necessary, it 
should be ground with water, and the floating particles 
decanted, until the whole is finished, after which the water 
should be evaporated off. 

Fell-spar may be procured, already ground, from the 
potteries, but as it is prepared in large quantities at those 
places, the proper care necessary in its selection cannot be 
depended on. To grind it -in quantity, a mill maybe made 
of flint stone, fitted in a tub, with a flat surface, and a 
rubber passing over it attached to an upright shaft and 
arm ; but for individual use, an ordinary Wedgewood 
mortar, with a leverage pestle, will be sufficient to grind, 
in a short time,, a plentiful supply. 



140 DENTAL SURGERY. 

KAOLIN, OR PORCELAIN CLAY. 

Kaolin is of a slightly yellowish color, inclining to 
white ; it is friable between the fingers, unctuous to the 
touch, and slightly adheres to the tongue ; absorbs water, 
and crumbles to powder ; but does not form a ductile 
paste. It is infusible, except with the addition of a flux. 
Kaolin is found in primitive rocks, where it occurs in beds 
more or less extensive. It is produced by the decomposi- 
tion of fell-spar. Large quantities of this clay is found at 
Monkton, Vt. y near Wilmington, Del., and near Phila- 
delphia, Pa., in several places. 

Kaolin is frequently obtained, en masse, with silex. In 
order to prepare it for use, it should be washed in six or 
eight times its bulk of water, and broken with the fingers 
until the clay is entirely dissolved ; then decant the liquid 
and evaporate it. 

Kaolin, from its extreme opacity, is used only in the 
body of the porcelain teeth, and in translucent teeth, is 
omitted almost entirely, reserving sufficient to keep the 
mass together while moulding it. This ingredient enters 
largely into the composition of Wedgewood mortars. 



SILEX, OR QUARTZ. 141 

SILEX, OR QUARTZ. 

There are many varieties of quartz, differing in their 
external characters, but when subjected to the furnace, 
yielding the same results ; being perfectly white and infusi- 
ble, except with potash, with which it forms a translucent 
glass. In the composition of porcelain it unites with fell- 
spar, and forms a hard, semi-vitreous, translucent body. 
In the moist state it is inadhesive, and consequently is 
carved with difficulty. The addition of kaolin clay gives 
it plasticity, but renders it opaque in proportion to the 
amount used. 

Many of the varieties of quartz are found, uncrystal- 
lized, in a massive k state. The crystallized specimens are 
to be preferred in making porcelain ; being generally more 
pure, and free from iron, they give a clearer translucency. 

Quartz abounds in almost every part of the globe. Fine, 
specimens are found on the borders of Lake George, N. 
Y., and in Frederick County, Md. In the latter place, 
according to Dr. Hayden, " the crystals are scattered on the 
surface of the ground, and are perfectly transparent." In 
Vermont, South Carolina, Massachusetts, and many other 
places in the United States, rock crystals of exceeding 
beauty are found. In the absence of crystallized quartz, 
the massive species subserves a very excellent purpose. 

In preparing this mineral, it should be carefully selected 
from others that may be found with it, and calcined to 
render it the more easily reduced to that minuteness of 
division so essential, owing to its infusibility, in its use. 

Quartz combines in the proportion of two parts to five of 

fell-spar, to form a translucent paste for porcelain. 
13 



CHAPTER III. 



THE COLORING PRINCIPLES OF PORCELAIN. 

It is a great desideratum, in the manufacture of teeth from 
this composition, to give them a color suited to the different 
shades of the natural teeth. Porcelain, in its simple state, is 
of a milky whiteness, except some portion of the ingredients 
contain iron, which is often found combined with quartz ; 
when such is the case, maceration in diluted sulphuric acid 
will take up the iron, and it may in that way be washed 
out. The materials used for coloring, consists entirely 
of metallic oxides and granulated metals. 

Before incorporating the coloring matter with the mass 
of the composition, it should be finely ground with a small 
portion of it. I prefer keeping it in that way, proportioned 
in given quantities, than by weighing each time of its use, 
the amount required ; a greater certainty is had of exact 
proportions, and the coloring more generally diffused. 



13 



OXIDE OF GOLD. 143 

OXIDE OF GOLD. 

This preparation is invaluable in the coloring of porce- 
lain ; to the teeth, in minute proportions, it gives a reddish 
lively appearance so apparent in the natural tooth, and in 
the imitation of the gums is indispensable. 

It is made by dissolving pure gold, either in oxy-muriatic 
or nitro-muriatic acids. Oberkampf prefers the former, 
because a purer solution is obtained, and one which can 
more easily be had free from an excess of acid. 

Nitro-muriatic acid is prepared, by mixing two parts by 
weight of nitric acid with one of muriatic. Vauquelin 
reverses these proportions, and says, "three parts of an 
aqua regia, so composed, I find are equivalent, to four made 
with the usual proportions." 

Muriate of gold prepared by either of these solutions, is 
decomposed by solutions of fixed alkalies or by the oxides 
of other metals. 

A solution of pure ammonia, with the muriate of gold, 
forms a precipitate of the oxide of gold united with a small 
portion of the ammonia. This compound is known by 
chemists as a very dangerous fulminating powder. 

The preparation of the oxide of gold in this manner has 
been recommended by some, who, ignorant of the actual 
result, have endangered the lives of those that prepare it. 

Some years ago, a variety of oxides which I had obtained 
from different chemists, proved useless for the purpose I 
had bought them ; I therefore determined to fuse them to- 
gether, and for that object, placed them in a crucible to be 



144 MECHANICAL DENTISTRY. 

subjected to the heat of a smelting furnace. Scarcely had 
the crucible grown hot, before an explosion took place, 
scattering the whole apparatus in every direction, to my 
then surprise and horror, for I could not imagine at first 
the cause that had produced it. 

The result of oxides of gold vary according to the tests 
employed in their decomposition : some give to porcelain a 
purple, some a red, and others a brown color; a union of 
the two first approaches nearest to a gum tint. Tin appears 
to be the most used to obtain what is called the purple 
powder of cassius. The protoxide of tin, made by expos- 
ing it in a fluid state to the action of the atmosphere, and 
collecting the oxide which forms as a crust on the surface. 
The same metal dissolved in nitric or muriated acids, pro- 
duce the same result. 

Strips of copper, rolled thin and suspended in the muriate 
of gold, will give an oxide yielding a very fine tint for a 
gum color. 

An ethereal solution of gold will be found useful and con- 
venient, sometimes producing a very natural tint of red — 
it is prepared by adding the either to a solution of gold in 
nitro-muriatic acid ; the gold is precipitated, but is again 
soon re-dissolved by the either ; the acid can be poured off 
and the solution evaporated to dryness. 

The following process* of obtaining the oxide of gold is 
by Thenard, it is rather tedious, but if carefully made, will 
produce a very desirable oxide. 

" Make an aqua regia of muriatic acid one part, and 

<< * Goddard on the teeth." 



OXIDE OF GOLD. 145 

nitric acid two parts, to dissolve the gold ; when it is dis- 
solved dilute it with water and filter ; then make it very 
dilute with an addition of water ; then dissolve pure tin in 
a mixture of nitric acid one part, and water two parts, to 
which add one hundred and thirty grains of common salt 
to each pint of the diluted nitric acid ; the tin should be 
added a small piece at a time, until a sufficiency to make 
the solution of a yellow color ; the operation should be con- 
ducted in a cool place ; when it is finished, filter and 
add about one hundred times its volume of water. Place 
the diluted solution of gold in a glass vessel and add 
the tin, drop by drop, stirring with a glass rod incessantly, 
until the liquid takes the color of port wine ; let it stand, 
and large flakes of the gold will be precipitated of a purple 
color ; decant the solution ; wash and dry the precipitate." 
" The best process for obtaining oxide of gold, according 
to Pelletier, is to precipitate chloride of gold by magnesia. 
Muriate of magnesia is formed, which may be removed by 
washing, and the excess of magnesia may be dissolved by 
diluted nitric acid. In this case, the magnesia is doubtless 
first converted into a chloride, and parts with its oxygen to 
the gold. The oxide must be dried at a low heat." 



13* 



146 MECHANICAL DENTISTRY. 

PLATINA. 

Platina is the least fusible of all metals, but when 
reduced to an oxide, and incorporated with a fusible sub- 
stance, is capable of extreme divisibility, and imparts a 
greyish blue color of a murky appearance. It has been 
found highly useful in the coloring of porcelain for the 
purposes of artificial teeth, giving the most natural blue 
color. It is used in the form of filings, sponge, and 
oxides. 

" The sponge of platina is prepared by dissolving the 
metal in nitro-muriatic acid ; that is, a mixture of nitric 
acid, one part, to two of muriatic. Ammonia, or muriate 
of ammonia, and common sal ammoniac, is added to this 
solution, which produces a yellow precipitate. When this 
precipitate is exposed to a red heat, in a crucible, the 
acids and ammonia are driven off, and there remains pure 
platinum, in the form of a delicate spongy mass. Another 
method of obtaining the sponge, is to throw the yellow 
precipitate on filtering paper, and when the liquid has 
passed through, to dry the paper and introduce it, with 
the adhering precipitate, into the crucible." 

Platinum may be advantageously used by fusion with 
five times its weight of pure gold, and reduced to particles 
with a very fine file ; or by dissolving it in aqua regia, 
to evaporate and wash off the acid. 

The oxide of platinum is obtained by dissolving the 
metal in nitro-muriatic acid, decomposing with lime water, 
and the precipitate re-dissolved in nitric acid. 



TITANIUM. 147 



TITANIUM. 



Titanium is found, in large quantities, in Bucks and 
Montgomery Counties, in Pennsylvania. It is always 
obtained in the form of an oxide, but, by analysis, the 
existence of a metal is evident. " The native oxides of 
this metal sometimes occur in long, striated, acicular crys- 
tals, of a reddish brown color and shining metallic lustre. 
Such crystals are sometimes contained in transparent pieces 
of quartz, forming specimens of singular beauty." 

Titanium gives a bright yellow, when used alone in the 
composition of teeth. It is improved by the addition of 
the blue oxide of cobalt, in proportions of ten to one, and 
may also be used to advantage, by small quantities, in the 
oxide of gold, to form a gum color. 

As titanium is often found combined with the ores of 
iron, it should be selected with care, and the strength and 
nature of the color made from it, tested before it is 
embodied in the composition of the teeth. The color pro- 
duced from iron is analagous, but not capable of with- 
standing much heat, therefore useless as an ingredient in 
the coloring principle of porcelain. 

Titanium is infusible by a common blow-pipe, but with 
the addition of a flux readily unites with it. 



148 MECHANICAL DENTISTRY. 

BLUE OXIDE OF COBALT, OR ZAFFRE. 

This oxide, in conjunction with the sponge of platinum, 
yields a very natural blue tint; if used alone, the color is 
too bright and conspicuous, unless in very small quantities. 
If an enamel of a light shade is required, cobalt, in 
minute proportions, with titanium, will give the desired 
tint. It is seldom used separate, and combines with a 
better effect with other preparations. With the oxide of 
gold, a very excellent shade of blue, with red spots or 
veins of a delicate hue, is obtained, well adapted for the 
surfaces of teeth next to the cutting edges. A more beau- 
tiful effect is exhibited in using them separately, by pre- 
viously coating the tooth with gold upon the whole 
exterior surface, and then applying the yellow and blue 
enamels as directed in the process for enamelling. 

Cobalt, as a coloring principle, was discovered in the 
year 1640. The name is derived from the German, 
Cobalus, given by the miners to an evil spirit supposed to 
haunt them in their labors, by raising their expectations 
when nothing was to be realized, the uses of cobalt being 
then unknown. It was once a custom to introduce into 
the church service a prayer, " that God would protect 
miners and their works from Kobalts and spirits." 

Cobalt is found, in this country, in a mine in Chatham, 
Conn., now abandoned from the poverty of the mine. The 
principal part now used comes from Saxony, where the 
cobalt mines have been long wrought with great profit. 






URANIUM. NICKEL. 149 



URANIUM. 



This metal is reduced to its pure state with great diffi- 
culty, even in the laboratory of the chemist. 

According to Klaproth, uranium is of a dark grey color, 
with a metallic lustre and granular texture. It is soluble 
in nitric acid, fuses with great difficulty, and affords a deep 
orange color to porcelain enamel. 

The article sold by chemists as the oxide of uranium, is 
composed of two parts of the metal and three of the 
oxide, forming a yellow powder. In the use of it, it com- 
bines well with titanium in equal proportions, but for the 
most natural tints of yellow, should be used in smaller 
proportions, about one to four. The addition of platina, 
finely reduced, to the two ingredients, according to the 
depth of color required, form a very natural shade. 



NICKEL. 

This metal is of a greyish white color, rather scarce, is 

malleable and fusible. The oxide, made by dissolving the 

nickel in nitric acid, produces a delicate tinge of grey ; 

the color is not permanent, being dispelled by a high heat. 

i 
It may be used in the composition of porcelain that is 

easily fused. 



CHAPTER IY. 



FORMULAS. 



OPAQUE PASTE, NO. I. 



R. Fell-spar, 12 ounces. 

Kaolin Clay, - - - - 4} " 
Silex, ----- 4f " 



5 



OPAQUE PASTE, NO. II. 

R. Fell-Spar, ■» 6 ounces. 

Kaolin Clay, ... 2 " 
Silex, 2 " 

Note. — No. 2 is more easily fused than No. 1, and less 
opaque. 

TRANSLUCENT PASTE, NO. I. 

R. Fell-spar, 4 ounces. 

Silex, - - - - - 6 pennyweight. 

Kaolin Clay, 4 






FORMULAS. 15 L 



TRANSLUCENT PASTE, NO II. 



a 
a 



B. Fell-spar, - - - - 10 ounces. 

Silex, 4 

Kaolin, ----- J 

TRANSLUCENT PASTE, NO. III.* 

R. Fell-spar, - - - - 10 ounces. 

Silex, 4 " 

Kaolin Clay, - - - 1 



a 



ENAMELS. ] 

FOR OPAQUE PASTE, NO. I. 

R. Fell-spar, .-.,-.-•- 6 ounces, 

O. Paste, No. 1. (dry,) - 1 " 

Flint Glass, - i " 

FOR OPAQUE PASTE, NO. II. 

R. Fell-spar, - 6 ounces. 

0. Paste, No. 2. (dry,) - 1 " 

Flint Glass, - i " 

FOR TRANSLUCENT PASTE, NO. I. 

R. Fell-spar, - - - - 8f ounces. 

Flint Glass, - - - - 4f " 

* This composition I use for making blocks, or sections of teeth, Jbr 
permanent sets ; and the opaque for temporary ones. 



152 MECHANICAL DENTISTRY. 

FOR TRANSLUCENT PASTE, NO. I. 

R. Fell-spar, - - - 3 d w t. 

Flint Glass, - - - - 3 " 

Kaolin Clay, - - - -• 2 " 

Silex, 2 a 

FOR TRANSLUCENT PASTE, NO. II. 

JR. Fell-spar, - - - - 11 ounces. 

Flint Glass, ... 7 d w t. 10 grs. 

FOR TRANSLUCENT PASTE, NO. III. 

R. Fell-spar, - - - - 11 ounces. 

Flint Glass, ... 7 dwt. 6 grs. 

ENAMEL FOR GUMS. 

R. Fell-spar, - - - - 6 dwt. 

Paste, (dry,) - - - - 4 " 

F. Glass, - 6 grs. 

Color with oxides of gold and titanium. 

Note. — In making enamel for the gum, it may be varied 
to suit the different compositions by substituting the same 
paste as a component part. 

As the process of coloring chiefly depends upon the purify 
of the material used, and to suit a great variety of cases, 
it would seem almost superogatory to specify quantities, I 



FORMULAS. 153 

will, however, add a list of a few of the proportions 
according to my oxides, which may serve as an assistance 
in the first compounds. More or less may be used, as 
required. 

For translucent paste, to color fifteen ounces of the 
composition yellow. 

R. Ox. Titanium, - - - -32 grains. 
Platina Sponge, - - - 4 " 

For the same, to make a murkey, dull blue. 

R. Platina Filings, - - - - 20 grains. 
Ox. Titanium, - - - - 6 " 

For translucent enamel, to produce a yellow tint in 
eight ounces. 

R. Ox. Titanium, - - - - 40 grains. 
Platina Sponge, 5 



a 



For the same, to make a dull blue. 

R. Platina Sponge, - - - - 12 grains. 

Ox. Titanium, - - - 6 " 

For the same, to obtain a brighter blue. 

R. Ox. of Cobalt, - - - - 20 grains. 

Platina Sponge, - - - 5 " 



The opaque compositions require about one-fifth more 
coloring than the translucent. 



CHAPTER V. 



MOULDING OF PORCELAIN TEETH. 

In the moulding of porcelain teeth, the incisores and 
cuspidati only are completed by the process ; the bicus- 
pides and molares require their grinding surfaces to be 
indented after they are taken from the moulds. 

To prevent the composition from adhering to the 
moulds, they should be slightly coated with sweet oil ; the 
platinas may then be inserted in the holes made to receive 
them, and a sufficient portion of the material placed in 
each of the cavities for a tooth. The halves are then 
clamped together and gently warmed. When the teeth are 
sufficiently dried, the division of the mould may be sepa- 
rated, and slightly tapped on the reverse side to remove 
any of the adhering teeth. 

The same process is adopted in moulding pivot-teeth ; 
in boring the holes of which, a running screw is inserted 
to remove the redundant paste, followed by a plain piece 
of wire, square at the ends, to finish with. 



ARTICULATOR Y GUIDES. 155 

ARTICULATORY GUIDES. 

In order to obtain a proper prominence, curvature, and 
length to the artificial teeth, corresponding with antago- 
nist teeth, and in conformity with the articulation of the 
jaws, a guide of wax, or other plastic substance, will be 
found necessary. Some operators depend entirely upon a 
double cast, but experience has convinced me of the 
superior advantages of the guides, especially in making 
sets for an entire jaw, over the articulating model. 

They may be made of wax or plaster of Paris, cemented 
to plates accurately fitted to the mouth, and then trimmed 
of the form required by the artificial process. The centre 
of the mouth, designated by the froenum, the dividing 
line of the dental arch, should be marked upon them. 
When necessary for whole sets, spiral springs may be 
attached to render more convenient the management of 
them. 



156 MECHANICAL DENTISTRY. 

CARVING OF PORCELAIN. 

After obtaining the " guides," the spiral spring should 
be removed, and each jaw placed upon its respective 
mould, which is laid out as represented in fig. 2, plate 2. 
Letter a describes the centre of the mouth, b c the lines 
between the cuspidati and first bicuspide, d e the extreme 
limit of the molar teeth. The dotted horizontal line is 
drawn parallel with the edge of the wax, describing the 
intended length of the teeth. Cards or pieces of tin are 
then to be cut, {see fig. 3,) corresponding with the base of 
the model and the protuberance of the guide, to suit each 
line on the model ; and the distance from the horizontal 
line to the guide is taken with a pair of dividers. The 
cards should be marked, to designate their particular 
reference. 

A portion of paste is taken upon the tile and worked 
with a spatula, and afterwards with the hand, until it is 
rendered as solid as possible ; it is then divided in three 
parts, for the three different sections required. One is 
placed upon the model, and when dry removed, and the 
other two, one on each side, pressed on their respective 
parts. The paste should not be quite dry or it will not 
carve as smoothly as it otherwise would. The pieces that 
are not in process of carving should be placed under cover 
to keep them moist. The front block is to be carved first, 
by trimming it to the required shape and height, with the 
assistance of the cards, a b c, and the dividers. The 
exterior surface should present an even frcnt, with a 



CARVING OF PORCELAIN. 157 

gradual curve, corresponding with the guide. The teeth 
are laid out according to Jig. 1, plate 3 ; the central 
incisores and cuspidati of the same width, and the lateral 
incisores from one-third to one-fourth narrower. The teeth, 
when carved, should extend about the one-sixteenth of an 
inch back of the lines b and c, and the back sections the 
same distance front, as the combined shrinkage is equiva- 
lent to one-eighth of an inch, and should be equally divided 
between the blocks. The difference between the height of 
the block made on the model and transferred to the plate, 
will be sufficient for the shrinking in length. 

The teeth are cut at the base next the gum very nearly 
describing a letter V ; the prominence on the cuspidati is 
added after they are carved. The inside is to be cut out, 
to clear the opposite teeth and tongue, as described in Jig. 
2, with holes bored, one for each tooth, and countersunk 
to receive the rivet heads. The teeth may then be sepa- 
rated with a thread, fastened as a bow to a piece of whale- 
bone, and finally finished in shape. 

The back blocks comprise the bicuspidati and two 
molars, and are regulated in their shape and size in the 
same manner as the front blocks, using the cards 6, c, d, e. 

A hole is bored through the second bicuspide, to receive 
the wire for the spiral spring to rotate on ; the other teeth 
each are perforated from the centre of the grinding surface 
to the base, and, finally, the three sections are mitred 
together as accurately as possible. 

No man can expect to enter at once upon the process of 
carving teeth with the most explicit rules before him ; per- 
fection must be the result of experience and constant 
14* 



158 MECHANICAL DENTISTRY. 

practice. The student should keep before him the 
characteristics of nature, and in carving, allow for the 
enamel and subsequent change in the baking of the 
teeth. 

The foregoing rules relate to the making of whole sets, 
but will equally apply, in the general principles, to parts of 
sets. The dentist possesses a facility in making his own 
teeth that he cannot have if he buys them. Frequently 
he is required to supply deficiencies in teeth and gums, or 
to make teeth of a peculiar construction, which he might 
not be able to select from a large stock of ready-made 
teeth, and can only furnish to his own, and the satisfaction of 
his patient, by having the means at home of making them. 

Figures 3 and 4, plate 3, exhibit specimens of some of 
the deviations from the ordinary forms of carving teeth. 

Fig, 3 is a case of the two central and left lateral 
incisores, the roots of the central teeth having been out 
some time, and the alveolar become entirely absorbed, 
while the fang of the lateral incisor remains in the mouth. 
They are supported as described in the figure, but may be 
mounted on a plate, fastened by rivets, or soldered to 
platina points. Frequently the operator is called on to 
supply large cavities in the gum, occasioned by fractures 
of the alveolar, which can only be done satisfactorily by 
carving them for the occasion. 

Fig. 5 is a style of single teeth, with gum parts attached. 
They are made so that they will fit together and present a 
regular form, but as they depend upon the platinas for sup- 
port, cannot be as strong as blocks riveted on. Where a 



ENAMELLING. 159 

particular object exists in having the teeth light and roomy, 
they will answer an excellent purpose. 

I sometimes make single molar teeth, perforated from 
cutting edge to base, with a square indent on the grinding 
surface to rivet or solder on. 

Whole sets may be made very light by inserting platinas 
in the posterior surfaces, and soldering them on the plates. 
Teeth made in this way need not be heavier than a similar 
combination of single teeth. 



ENAMELLING. 

The enamelling of porcelain gives to it the finish, and is 
the final process before baking. It is very essential that 
the enamels be kept free from dust, a small portion of ex- 
traneous matter may fall upon the front surface of a tooth, 
and destroy entirely the beauty of its appearance. 

Before coating teeth made from the translucent material, 
it should be bisketed hard enough to be scraped with a 
knife, otherwise it will be very likely to crumble in the 
hand. Opaque teeth may be enamelled without it. 

The composition of which the teeth are made should be 
slightly saturated with water from a hair pencil before 
placing on it the enamel, without which, the enamel will 
settle in lumps and not spread upon the surface. 



160 MECHANICAL DENTISTRY. 

After having thoroughly stirred the enamel, so as to mix 
any settled portions of it, commence at the base of the tooth 
with the yellow, bringing it down about half way, then 
with a knife trim it off to a feathered edge, and put on the 
blue enamel from the cutting edge nearly to the base of the 
tooth. When dry, carefully trim away the inequalities and 
brush off the surface. 



BAKING OF PORCELAIN TEETH. 

This process may be divided into two characters, that 
commonly called biscuiting, which is understood by baking 
the teeth sufficiently to allow them to be enamelled without 
danger of breaking ; and fusing them to a certain point by 
which they are finished ready for insertion. In the first 
process, only a moderate degree of heat is necessary, but 
the latter frequently requires the maximum point to be 
obtained, and with an exactness that may determine its 
durability and depth of color ; too much heat destroys the 
tenacity of porcelain, and also the coloring matter, while 
too little leaves the surface rough and the composition 
brittle. 

In the painting of porcelain, less heat is required than in 
the fusion of the first enamel, and the depths of tint are 
determined by more or less heat. 



BAKING OF PORCELAIN TEETH. 161 

Furnaces of different sizes and shapes may be obtained 
from the manufactories, or they may be made of fire brick 
to suit the fancy. In the construction of a furnace, the 
muffle should not be too near the grate, plenty of room 
should be allowed for the main body of the coal under the 
muff, as that portion remains a longer time ignited than the 
rest, and is liable to burn out before the whole mass 
becomes thoroughly ignited. 

For ordinary use, a furnace having a muffle ten inches 
long by three in width will be large enough ; with it, one 
whole set and fifteen or twenty single teeth may be baked 
at a time, with the opportunity, sometimes, of repeating the 
process by one fire. 

By practice, the dentist will be able to judge when the 
teeth have received sufficient heat ; but until he can do 
that with certainty, recourse may be had to trials, placed 
on the slide in front of the teeth to be baked, withdrawing 
one from time to time, until they indicate the desired point ; 
the draught should then be instantly closed, the slide drawn 
out gently, and] not exposed to any sudden blast of wind 
until entirely cold. To prevent teeth from adhering to the 
slide, it may be sprinkled over with fine silex. It has been 
a common, though useless practice, to place blocks of teeth 
upon pedestals of Kaolin clay to preserve their form on the 
base ; with the composition I have recommended, no neces- 
sity of such an arrangement is required ; the material will 
retain its shape as long as it remains uninjured by the heat 
in other respects. 



CHAPTER VI 



PLATES FOR MOUNTING PORCELAIN TEETH. 

The original manner of securing these teeth in the mouth 
was by attachments of wire to a small plate resting on the 
gums ; this practice has almost altogether grown into disuse, 
and is now only resorted to by a few individuals, who, 
advertising at low rates, are regardless of the instability of, 
or evil consequences arising from their operations. 

The objections to the insertion of teeth in this manner 
are numerous. The wire is oftentimes forced into the gum, 
producing an inflammation of the parts and subsequent loss 
of the adjoining teeth. And the constant action of the 
wire upon the supporting teeth soon wears a deep cavity in 
the enamel, frequently occasioning the entire destruction of 
those teeth ; besides, they are never worn with comfort, 
and are seldom as firmly fixed as they should be. 

Plates, to be worn comfortably and without injury to the 
gums or remaining teeth, should cover as great an area of 
surface as compatible with the circumstances of the case ; 
by that means the pressure is diffused more generally and 



PLATES FOR MOUNTING PORCELAIN TEETH. 163 

equally, than if confined to a slender strip of plate or wire ; 
the adhesion to the gums is also greater, and less strain is 
exerted upon the supporting teeth. 

Clasps of broad plate should be soldered on, extending 
around a molar or bicuspide ; the incisores and cuspidati 
should on no occasion be used for such a purpose. It is 
sometimes expedient to attach to more than one tooth on 
each side, by soldering on a piece pressing against the 
inner side of such teeth, thus constituting a lateral pressure, 
which is frequently sufficient without extending the clasp 
entirely around either tooth. Clasps embracing teeth should 
not be soldered upon their entire rim ; a sufficient space 
should be left open to allow them to be tightened or relaxed, 
as the occasion may require. 

In order to insure a correct adaptation of the plate, a 
faithful model in plaster of Paris is necessary, showing 
all the prominencies and cavities of the gum. From it, a 
corresponding one of brass or spelter is made, with a 
female counteipart of lead, to be used as a die for 
s wedging the plates. 

The form of the plate should be marked upon the 
model with a pencil, and a piece of sheet lead or paper 
cut to suit it ; from this the dimensions of the gold or 
silver may be obtained. If there are teeth in the mouth, 
the plate should be cut out in semi-circular notches to 
fit such teeth as it passes, having the points rounded off in 
the apices of the gums, to prevent any injury to the mouth 
from them. 

Gold or silver plate should weigh about two and a half 
pennyweight to the square inch ; for brackets it should be 
at least one-fourth heavier. 



164 MECHANICAL DENTISTRY. 

In the mounting of single teeth, the plate should extend 
under the base, in order to give them a bearing upon it, 
without depending upon the platinas for support. In 
blocks or sections, the plates ought to extend out at least 
even with the anterior edges of the block, and if not 
interfering with the soft parts of the mouth, they should 
be continued on the gum as far as possible. It is also 
necessary that the molar and bicuspides have their entire 
bearing upon the plate, as they are thus stronger and more 
comfortable to the wearer. 

When the jaw is entirely destitute of teeth, and the 
fangs have all been removed, a plate covering the whole 
alveolar ridge will be necessary. On the palatine side a 
portion may be cut out, leaving more or less, according to 
the extent of surface covered by the plate on the anterior 
part of the gums. The plate on the lower jaw should 
extend on either side of the summit of the alveolar ridge 
about half an inch, or as deep as the soft parts will allow. 
This plate should be at least of one-third heavier metal than 
the upper one. m 

In making large plates for the attachment of teeth, the 
intervention of one or more teeth require an additional piece 
fastened to the plate opposite those teeth to strengthen it. 

Teeth supported without the aid of clasps, is understood 
as retained by atmospheric pressure ; the principle is often- 
times imposed upon the ignorant without the practice. 
Some individuals, by means of attachments of small points 
of wire or plate pressing against the natural teeth, impose 
the idea upon those who know no better, that they are 
supported by atmospheric pressure, the least injurious of 



PLATES FOR MOUNTING PORCELAIN TEETH. 165 

any manner, while, in reality, they deceive them with the 
most pernicious practice to be chosen. 

The proper insertion of plates, upon the principle of a 
vacuum, is generally attended with successful results. 
The adhesion is, according to scientific experiments, equi- 
valent to fifteen pounds to the square inch ; therefore, in a 
plate of ordinary dimensions, covering an area of from 
four to six square inches, the sustaining power is equiva- 
lent to from sixty to ninety pounds. This pressure, of 
course, is not attained at once. Notwithstanding how 
accurately the plate may fit the gums, it is an impossibility 
to obtain a perfect adhesion of surface ; the gum will 
gradually yield to any unequal pressure, and adapt itself, 
ultimately, to any slight discrepancies of the plate. 

Some writers have denied the practicable application of 
teeth inserted in this manner, but twelve years experience, 
with almost universal success, has convinced me of its 
utility and general practicability, notwithstanding all that 
may be urged against it. 

When both jaws are furnished with entire circles of 
teeth, they may be attached together with spiral springs, 
resting upon hinges secured in the second bicuspide, 
having the inner end riveted to an upright strap of plate 
soldered to the main one, and lying close against the pos- 
terior side of the section. 

A full set of teeth should not exceed fourteen in num- 
ber ; the contraction of the jaw, occasioned by the 
absorption of the alveolar, precludes the possibility of 
inserting more without injury to their symmetry and natural 

appearance. 
15 



166 MECHANICAL DENTISTRY. 

When it becomes necessary, as is often the case, to 
insert the inferior bicuspides and molares, the six front 
teeth remaining sound, in their natural condition, two 
plans are suggested. The first is by carving a section for 
each side of the jaw, to rest upon the gums, and connected 
together by a bar of metal, with the ends embedded in the 
posterior surface of the block, and flush w T ith it. This bar 
may be fastened with rivets, soldered or riveted to it. 
The bar should be very stout, weighing from five to six 
pennyweight. 

The other plan, is by swedging a plate to fit the gum, 
with the bar soldered to it, the section being riveted on the 
grinding surface. 

As no more strength or accuracy of fit is obtained by 
the latter practice, no preference of its adoption can exist ; 
the porcelain will present as smooth a surface as the 
metal would. 

During the process of swedging, the plate should be fre- 
quently annealed. 

If, as it is sometimes necessary, a hole is required in 
the metal to admit the passage of a natural tooth, the one 
upon the die may be cut off nearly level with the gum ; 
the edge of the protuberance will generally excise a piece 
of the size and shape required, by the swedging of the 
plate. 

When it is desirable to attach a pivot for the support of 
a combination of teeth, the spring pivot, heretofore recom- 
mended, will answer an excellent purpose. 



LIGATURES. 167 



LIGATURES. 



As the mode of inserting teeth by means of ligatures is 
still practised by the uninitiated, a mere sketch of some of 
the objections may not be inadmissible. Teeth inserted in 
this manner depend wholly for support upon the contiguous 
teeth, to which they are attached, and either, by the exces- 
sive lateral power they exercise, eventually draw the tooth 
from its socket, or pressing it against the artificial one, by 
the constant attrition which is kept up, produce decay in the 
sound tooth. Another objection is the wear upon the natural 
tooth. I have seen teeth cut deeply into the bone by such 
fastenings. The practice of some professing to be dentists, 
and securing porcelain teeth by means of slender wires, is 
no improvement on the old practice of insertion by liga- 
tures. 

The folly and ignorance of this custom, in the present 
advanced state of the art, affords a sufficient plea for not 
pursuing the subject further, as I am satisfied that it is 
practised by no one ignorant of the effects, though they 
may be incapable of a more judicious method. To such 
persons advice would only be "as chaff thrown before the 



wind." 



168 MECHANICAL DENTISTRY. 

SELECTION OF PORCELAIN TEETH. 

The dentist, in his selection of teeth to particular cases, 
should choose an assortment corresponding in size and 
shape with the remaining ones. If there are no teeth of 
the same description in the mouth, he should be governed 
by the general circumstances. 

Persons of small stature usually have small teeth ; if the 
deficiencies of the gum require them to be long, it should 
be supplied with gum teeth, or in case of the absence of 
several contiguous teeth, they may be made in sections of 
not more than six each. 

In determining the color of the artificial teeth, the ope- 
rator should first remove any extraneous matter that may 
be deposited upon the natural teeth, and then select by a 
careful comparison. It is not uncommon to see teeth of 
a very light shade placed alongside of one that is much 
discolored and blackened, thus, by the contrast, at once 
exhibiting the intervention of art. We are often desired 
by patients " to make their teeth white." No dentist with 
a proper estimation of his own judgment should allow any 
dictation ; he alone should be the umpire, and decide, 
according to his own taste and skill 3 the form and color to 
be given to artificial teeth. 

When there are no front teeth remaining in the upper 
jaw, the incisores of the lower jaw must afford the requi- 
site guide ; and in cases of entire destitution, the age and 
complexion of the patient should be taken into considera- 
tion. 



FITTING OF PORCELAIN TEETH TO PLATES. 169 

With young persons light shades may be chosen with 
propriety ; in individuals of advanced ages, a predominance 
of yellow is better suited. Light complexions require 
light colors of teeth, and dark complexions vice versa. 

The peculiar temperaments may assist in the selection of 
shades of color of artificial teeth. In the sanguine we 
find very light blue shades, and in the bilious the yellow 
predominating. 



FITTING OF PORCELAIN TEETH TO PLATES. 

As porcelain teeth are differently inserted, according to 
the number and peculiarities of the case, it will be neces- 
sary to classify them, and consider the different varieties in 
practice as they occur. 

The mounting of any number of single teeth, is per- 
formed according to the same general principles ; we will, 
therefore, suppose the artist to have made his selection, 
which, under the circumstances, require some preparatory 
alteration. If, for example, they are too wide for the 
space to be filled, he commences by reducing them in 
width, proportionate with their character, allowing spaces 
between them ; that between the central incisores and the 
laterals and cuspidati should be equivalent to each other, 
and the space between the central and lateral incisores 
15* 



170 MECHANICAL DENTISTRY. . 

about half as much. The same rule should be followed 
with contiguous natural teeth as is observed with the arti- 
ficial ones, in order to present a uniformity in the mouth. 
It is always preferable to select teeth suiting as near as 
possible, in point of width, to avoid the necessity of cutting 
them on the lateral edges, as the acute corners necessarily 
produced give them an artificial appearance. 

The length of the teeth is the next consideration. 
Generally a necessary amount may be taken from the base ; 
in doing which, however, enough should be allowed for 
the shoulder resting on the plate, without impairing the 
strength of the low T er platina, by cutting away the sub- 
stance necessary for its support. Any surplus length may 
be taken from the cutting edges. This can be done when 
finished, and after they have been tried in the mouth. 

The model may be trimmed away a little under the base 
of each tooth to allow for its pressure on the gum ; this is 
generally only necessary with the six front teeth. 

The plate may now be placed on the model, and the 
teeth fitted to it on their base. Straps are then riveted to 
the platinas on the teeth, and extending to the gum plate, 
forming a neat joint to be soldered. The platinas should 
be scraped free from oxide before fastening the straps on 
them ; the straps and plate should also undergo the same 
treatment. 

When the teeth are plated and fitted ready for solder- 
ing, they should be adjusted on the model, according to 
the articulator or guides, whichever may be used, and 
retained in position by means of beeswax ; they may then 
be transferred to a large piece of charcoal having a cavity 



FITTING OF PORCELAIN TEETH TO PLATES. 171 

excavated in it, and luted with plaster of Paris, which, 
when dry, will admit of the removal of the wax, exposing 
the surfaces to be soldered. 

The charcoal should be coated on the outside with 
plaster of Paris, to give it strength and cleanliness. 

In the mounting of sections of teeth, they should be 
fitted on their base, as closely as possible, and mitred 
together at the ends. Any excess of length in the front 
section should be taken from the cutting edge, and, in the 
back ones, from the base. 

When sections are secured to the plates by soldering, 
a continuous strap, passing the entire extent of the block, 
is preferable over single straps ; it not only strengthens 
the apparatus, but excludes the secretions of the mouth 
from interposing between the teeth and plate. 

If they are fastened by rivets, after the fitting of them 
they are to be cemented* upon the plates, to hold them in 
their places whilst drilling the holes. Straps should be 
soldered upon the inside of the bicuspide to fasten the 
hinge to, on which the spiral spring vibrates. 

Rivets should be made of soft wire, one head being 
made previous to insertion, and, by resting it upon an 
instrument small enough to enter easily into the counter- 
sunk cavity, and held in a bench vice by means of a 
small hammer, the other end may be riveted on the under 
side of the plate, which should also be countersunk. 

* The cement may be made of gum mastich one part, with two of 
beeswax. 



172 MECHANICAL DENTISTRY. 

FINISHING OF PLATES. 

This is a part of the mechanical dentist's labors that is 
" more honored in the breach than in the observance," 
generally from an opinion that it is labor lost Such is a 
mistake, for he receives ample compensation from the 
filings and trimmings, especially of gold, without impair- 
ing the strength of the apparatus, and certainly contributing 
to the comfort of the patient, and his own reputation as an 
artist. The excess is generally in prominencies and upon 
the edges, that add nothing to the strength. 

The edge of the plate should be filed round and smooth, 
also the straps that support the teeth, and all redundancy 
of solder cut away with edge tools adapted to the purpose. 
The brackets intended to surround the natural teeth can be 
rendered elastic by hardening with a hammer. 

When the prominencies and edges are dressed off, the 
scratches and roughness of the surface may be rubbed 
smooth with a species of grit, known as Scotch stone, and 
a smoother surface obtained by finishing with slate 
pencil. 

When this process is completed, the plate should be 
well scoured with fine white sand and water, by which the 
coating produced by stoning is removed ; it is then ready 
for the burnisher. 



CHAPTER VII. 



SOLDERING. 

Much depends upon the nicety of this process, in finish- 
ing with neatness an apparatus to be worn in the mouth, 
and indeed the strength of it may be very much impaired 
by carelessness in the performance of it. 

To be able to properly unite two pieces of metal by sol- 
dering, it is essential to keep in view the principle by 
which it is done, viz : the adhesion of polished or clean 
surfaces by the interfusion of a softer metal. As a metal in 
a state of fusion inclines to a heated body in preference to 
another less hot, notwithstanding it may stand contiguous, 
we find the necessity of applying the heat more particularly 
where it is designed to attract the solder. In every case, 
to insure a smooth flow of the solder, the metals to be 
united should be in contact, and if any vacancy occur it 
may be filled by small pieces, accurately fitted in, and the 
surface scraped or filed clean. If a large body is to be 
soldered, the blaze should be full and general, so as to heat 
every part, and if there are teeth to be attached, very 
gradual and slow, to avoid the danger of breaking them. 



174 MECHANICAL DENTISTRY. 

When the entire mass is well heated the blaze may be 
brought to a focus, centering at the point to be soldered, 
always taking care to keep up the heat on the largest 
pieces, or else the solder will all flow upon the smaller 
ones. 

If the hydrostatic air pipe is used, the compass of the 
blaze may be regulated by gently moving the lamp to and 
fro, and by stopping off, as required, the supply of air by 
means of the cock in the branch pipe. 

If the blow pipe filled by the mouth is used, much 
practice is necessary to manage it with ease and facility- 
The artist should practice himself to inspire and blow 
without taking the pipe from his mouth. It may be 
acquired by breathing through the nostrils and respiring 
through the mouth, alternately. Without this acquisition, 
the process of soldering is painful and injurious, but with 
it, it becomes easy and innoxious. 

To facilitate the concentration of heat, the body to be 
soldered should be surrounded with charcoal, and no more 
plaster used than required to obviate the danger of it 
cracking and separating during the process. 

Solder should be cut in strips, longitudinally about the 
twentieth part of an inch, and transversely of the same 
length. The addition of a little flux, (borax,) rubbed in 
water on a slate, will facilitate very much the flowing of 
solder ; too much creates a glass, which, interposing 
between the surfaces, will exclude the solder, and some- 
times deceive the artist in his labors. 

To remove the crust of oxide and borax that accumu- 
lates in soldering, the metal should be boiled in a solution 



GOLD. 175 

of alumn and water, or placed for a short time in a diluted 
mixture of sulphuric acid. Immersion in water into which 
a small amount of the carbonate of soda is put, will neu- 
tralize the adhering acid, and destroy the objectionable 
acidulous taste left by the acid. 



GOLD. 

This metal is an indispensable one in its application to 
the purposes for which it is used in the dental art. In the 
surgical department it affords an excellent substitute for 
that portion of a tooth destroyed by caries, and in the 
mechanical serves to retain an artificial process in the 
mouth, free from the corruptibility of other metals. 

When used as foil, it should be of twenty-four carat 
(pure). For plate purposes, the addition of alloy, to the 
amount of one-sixth, thus reducing it to what is called 
twenty carat, is necessary. In its pure state it is soft, and 
with alloy it is rendered harder and more elastic. 

Of the two principal metals used for the adulteration of 
gold, silver is to be preferred ; it is less disposed to tar- 
nish in the mouth, which is the chief objection to the 
employment of copper. 

The gold coin of the United States, of the late issue, is 
about twenty-two carats (fine). 



176 MECHANICAL DENTISTRY. 

The gold coin of most European nations contains silver 
or copper, or both of those metals. 

The standard, or sterling gold of England, is composed 
of twenty-two carats or parts of pure gold, and two of 
copper. 

" The mode of computation by carats, with reference to 
the alloys of metals, has long been employed in England. 
Every mass of alloyed gold is supposed to be divided into 
twenty-four carats, or standard coin. This method does 
not so conveniently admit of the appreciation of various 
quantities of alloy as that adopted in France, where the 
pure gold in alloys is estimated at one thousandth parts; 
thus, gold of eighteen carats, or containing one-fourth alloy, 
would, by the French, be said to be of the standard 
expressed by '750." 






MELTING AND REFINING GOLD. 177 

MELTING AND REFINING GOLD. 

In refining the refuse of the gold drawer, it will be 
necessary to divide the filings from the clippings. Any 
iron that may remain in either may be extracted with a 
magnet ; after which the filings should be placed in a 
crucible, and exposed to a white heat in a small cannon 
stove.* When in a state of fusion add corrosive sublimate, 
in the proportion of four grains to the ounce ; if too much 
copper is supposed to be in the metal, the addition of salt- 
petre will serve to destroy it. After the insertion of the 
cor. sub. or nitre, let the gold remain under a strong heat 
for ten or twenty minutes, then pour it off, and re-melt it 
with the clippings in a new crucible. 

If during the process of milling, the gold is found to 
craze on its surface, it would be wiser to melt it over than 
to persevere in rolling it. If, by chance, the workman 
succeeds in extending it as much as necessary, it will be 
liable to break in swedging, or eventually in the mouth. 

If much difficulty exist in working gold, by melting it 
in a crucible, with a smaller one, inverted and perforated 
through the top, luted on, and adding an equal bulk of 
nitre, the gold will acquire a tenacity and toughness. "With- 
out some care considerable loss will take place during this 
process. 

The process of cupellation, is that of rendering pure 
either gold or silver, by fusion with the oxides of lead, 

* The stove, I have found, after using the forge for many years, more 
economical, convenient, and effective. 

16 



178 MECHANICAL DENTISTRY. 

which possesses the necessary property of uniting with all 
the metals but the two above named. It is performed by 
mixing the lead with the metal to be purified, and keeping 
it for some time in a state of fusion, in what is called a 
cupel ; by this means the lead becomes vitrified, and asso- 
ciating with all the base metals in the gold, falls to the 
bottom, carrying them with it, and leaving the gold or 
silver pure upon the surface. 



SEPARATION OF GOLD AND SILVER FROM 
IMPURITIES BY AMALGAMATION. 

The process of separating these metals from the frag- 
ments of crucibles and the refuse of the laboratory, is 
practised as a separate business by some, but the diffi- 
culty of access to them, and the entire dependence 
upon their honor, render it frequently necessary for the 
mechanical dentist to be able to operate for himself. The 
modus operandi herein suggested, may not be the most 
ready means of effecting the purpose, but it is given for 
what it is worth ; it is the result of personal experiment, 
and has always proved to me an efficient method. 

The crucibles and other matter should be finely ground,* 

* This is done by what is termed chasers, constituting two large 
wheels of iron, revolving on a bed plate of the same metal, under a 
pressure of one or two tons. Messrs. C. W. Roberts, & Co., of N. 
Water Street, Philadelphia, have, at considerable expense, erected an 
apparatus for this purpose. 



SEPARATION OF GOLD AND SILVER. 179 

and then treated with quicksilver, by thoroughly Stirling it 
through the mass ; the mercury will become separated into 
thousands of globules, taking up the gold or silver with 
which it may come in contact. The sand or dirt should 
then be transferred to a dish, a little at a time, and placed 
in a large tub having a stream of water constantly running 
into it ; by this process the mercury settles at the bottom, 
retaining the metals with it, and the dirt is washed out.* 
When finished, place the mercury in a glass retort with a 
receiver attached, (I use a small retort, having an oil flask 
luted on for a receiver,) and subject it, in a sand bath, to 
the action of a strong heat, which disengages the mercury, 
and drives it into the receiver ; you then have the quick- 
silver in one vessel and the gold and silver, en masse, in 
the retort. By subjecting these metals to nitric acid, the 
silver, and such portions of the mercury as may remain, 
is dissolved, leaving the gold in the state of an impure 
oxide in the bottom. It is necessary, as soon as the 
dissolution has taken place, to pour off the fluid, other- 
wise a reaction will occur, by which a portion of the silver 
is precipitated. 

The gold, in powder, is then placed in a crucible and 
subjected to a white heat, throwing in a small quantity of 
borax to act as a flux. When melted, take out the cruci- 
ble and suffer it to cool ; it may then be broken, and a 
button of pure gold is obtained. To separate the silver in 
the solution from the mercury, add, drop by drop, of 
muriatic acid ; this will produce a white precipitate, 

* Or it may be separated from the gold and silver by compression in 
a buckskin bag. 



180 MECHANICAL DENTISTRY. 

settling in flakes, which, if fused in a crucible, in the pro- 
portion of one part to three, of desiccated carb. of soda, 
will give a result of pure silver, which may be separated 
from the salt, when cold, by breaking with a hammer ; 
yielding in the proportion of .75 per cent. 



TABLE OF ALLOYS. 

The following table of alloys, of foreign and domestic 
coin, will be found useful in the reduction of gold and 
silver. 

" Alloy of gold coin, (Fr. standard,) Gold .900, Cop. .100. 
" " (Eng. stand.) Gold .916.67, Cop. and 

Silver, .83.33. 
" " (U. S. standard,) Gold .899.22, Cop. 

and Silver .109.78. 
" gold metals, (Fr. standard,) Gold .916, Cop. .84. 
For ductile gold, of 18 carat or 750 milliemes, Cop. .990, 

Gold .10. 

(The previous combination of the alloy is found to pro- 
duce ductile gold, when the same metals would prove the 
contrary if mixed directly.) 

Jewelry, (Fr. standard,) Gold .750, Cop. .250 



TABLE OF ALLOYS. l8l 



SILVER. 



Alloy of silver coin, (Fr. stand.) Silver .900, Cop. .100. 

(U.|S. stand.) Sil. .892.43,Cop. .107.57. 
* " (Eng. stand.) Silver, .925, Cop. .75. 

" silver plate, (Fr. stand.) Silver .950, cop. .50. 



The following compositions are recommended by Mr. 
P. N. Johnson, of London : 

Platina, .500, 1 

„^ } For pivots for artificial teeth. 
Silver, .500. J F 



FOR SPIRAL SPRINGS. 

Palladium, - - - - - .312.5 

Silver, .312.5 

Copper, ----- .312-5 

Iron, .62.5 

This alloy produces a degree of elasticity not excelled 
by steel, with the advantage of superior lightness and 
hardness over platinum." 



IT 



182 MECHANICAL DENTISTRY. 

SOLDER. 

Solder should be made as pure as will admit of its 
flowing smoothly under the action of the blow-pipe. 

Gold of 18 carat may be soldered with 13 carat solder, 
in making springs, but for the purpose of uniting teeth to 
the plate twelve carat should be used. 

FOR GOLD OF THE VALUE OF -750, OR 18 CARATS. 

IMGold of .750, - .666.67 

Copper, (watch dials,) - .166.66 

Silver, - - - .166.66 

GOLD SOLDER, OF 13 C. 



Gold, (of IS c.) 
Silver, 
Spelter, 
Copper, - 



Melt together the gold and silver, then add the copper 
and spelter, pouring off at a white heat. 

GOLD SOLDER, OF 12,! C. 



oz. 


dwt. 


grs 


1 


7 


12 




1 


12 




1 


00 




3 


00 






Gold, (18 c.) - 
Silver, 
Spelter, - 
Copper, - 



dwt. 


grs. 


- 13 


20 


- 1 


8 


- x 1 





_ 


12 





SOLDER. 






GOLD SOLDER. 




. Gold, (.pure.) 


... 


- 23 dwts. 


Silver, 


- 


- 6 " 


Spelter, 


- 


- 1 " 


Copper, 


_ 


- 3 " 



1S3 



SILVER SOLDER, NO. 1. 

Pure Silver, - - - - 1 ounce. 
Brass, L " 

*- 

SILVER SOLDER, NO. 2 

Pure silver, - 3 ounces. 

Copper, 18| dwt. 

Brass, 5J " 

SOLDER FOR PALLADIUM. 

Palladium, 4 ounces. 

Silver, 2 " 



184 MECHANICAL DENTISTRY. 

MILLING OF GOLD AND SILVER. 

Much depends upon the uniformity of size of gold and 
silver for dental purposes. In order to insure a plate of 
even thickness the dentist should be provided with a set of 
true and well-tempered rollers, of at least three and a half 
inches in length. 

Until within a few years, the best rolling mills were 
imported from Europe, at a very heavy expense, but 
recently, Mr. Lodge, of Dock street, Phila., has succeeded 
in hardening and finishing them fully equal to those of 
foreign manufacture. 

During the process of milling gold or silver, the metal 
should be frequently annealed, to obviate the liability of 
cracking. 

Rollers made of cast iron have been sold for steel ; they 
may be detected with a file ; as they are useless for gene- 
ral service, some caution should be observed to avoid 
imposition. 

A rolling mill should be firmly secured to the floor to 
keep it steady while using it ; the set screws should be 
brought to bear equally, and let down but a little at each 
passage of the metal. A hard draught is both liable of 
injury to the rollers, and calculated to break the metal. 

Gold or silver may be immediately thrown in water after 
annealing, as no sensible hardening is caused by it. Cop- 
per is hardened by immersing in water while hot ; so also, 
any metal alloyed with it. 



MILLING OF GOLD AND SILVER. 185 

TO MAKE SPIRAL SPRINGS. 

These springs are attached to upper and lower sets of 
teeth, and to upper sets only where there is not sufficient 
adhesion to retain them in their place. This necessity but 
seldom exists, and even in entire sets I frequently remove 
the springs after they have been worn two or three months. 
When spiral springs are designed to support an upper set, 
without a corresponding artificial set of teeth on the lower 
jaw, they should be fastened by clasps, embracing oppo- 
site molars, with a bearing on their grinding surface to 
prevent the band from pressing into the gum. 

Spiral springs should be made of eighteen carat gold, 
alloyed with copper, and drawn through plates from about 
the sixteenth of . an inch in diameter to the size of a 
fine needle, without annealing. The ends of the wire 
should be passed through alternately to equalize the 
temper of it. 

The wire is then coiled closely on a small-sized knitting 
needle, by making a block of soft wood for the wire to 
pass through, and screwing it into a bench vice, the needle 
being secured with one end of the wire in a hand vice, 
and carefully wound on until completed. 

Eyelets for securing the springs to the teeth are vari- 
ously constructed. The most durable and convenient to 
make, may be made by inserting one end of a piece of 
wire, large enough to admit of being screwed tightly in 
the spring, and bending the other end around the button.* 

* See plate \Y.,fig2. 



186 



MECHANICAL DENTISTRY. 



Another is to take a piece of plate about the width of the 
spiral, and file a shoulder on it sufficient to allow it 
to be fastened as above, having a hole pierced near the 
end, opening externally with a slit, which is to be pinched 
together in securing it. 

The length of spiral springs, independent of the eyelets, 
should be about one and a half inches. Sometimes it is 
necessary to make them longer or shorter, depending 
generally upon the size of the mouth. They should never 
be short enough to straighten upon the opening of the 
mouth to its greatest extent, nor long enough to strike the 
cheek upon the occlusion of the jaws. 

The eyelets should be about three-fourths of an inch 
from the point of rotation to the end, with about one-half 
inserted in the spring. 

The diameter of the spring, when coiled, should not 
exceed the tenth of an inch, otherwise it will be clumsy 
and in the way of the cheek. Some dentists flatten them, 
but as it is calculated to impair their strength and dura- 
bility is unadvisable. 

As it is not always possible to obtain metal having suffi- 
cient elasticity, of eighteen carat gold, it may be made to 
an advantage of fourteen carat, in the following propor- 
tions : 

Gold coin, (22 carat) - - - 1 oz. 
Siver, (pure) ... 3 dwt. 3 grs. 

Copper, (pure) - ■ - - - 3 dwt. 20 grs. 

Gold alloyed with one-twelfth part of platina will make 



TO MAKE SPIRAL SPRINGS. 187 

a very elastic spring, possessing the properties of pure 
gold in the mouth. Gold of fourteen carat may be 
annealed prior to drawing it through the last hole in the 
draw plate, and for some cases even after it is drawn to 
the required size, as it will retain its elasticity to a consi- 
derable degree after being heated to redness. 



CHAPTER VIII. 



TO MAKE A TRANSFER OF THE MOUTH. 

It is very important for the correct adaptation of artificial 
teeth to the gums and remaining teeth, if there are any, that 
a faithful representation of the mouth be obtained, which 
will enable the artizan to work with as much accuracy as 
if he had the natural mouth before him. 

Previous to taking an impression, all the preliminary 
changes should be made, if any roots are to be extracted, 
it should be done, so as to allow a sufficient time for the 
absorption of the alveolar. 

When a dependance is required upon a root, the pivot 
hole should be bored, and a loose temporary one placed 
there, projecting about the eighth of an inch, so that it may 
adhere to the wax and make an impression in the mould 
corresponding with the situation and inclination of the 
cavity in the root. 

The operator should be furnished with a number of 
frames made of tin, to suit the different size mouths ; into 
which the wax is to be placed for receiving the impression, 



TO MAKE A TRANSFER OF THE MOUTH. 189 

these frames vary from two and a half inches in width to 
three and a half. 

The wax (yellow is preferable to white, being more tena- 
cious,) is to be softened before a gentle fire, avoiding to get 
it too soft, as it will be liable to spread, then it should be 
forced upon the gums until a fair and perfect impression is 
obtained ; to accomplish this as it should be, it is necessary 
that the pressure be universal, and not alternating from 
side to side. 

The gums should always be wiped dry with a soft nap- 
kin before taking the form with the wax. 

To obtain a double cast of the gums, giving the articu- 
lation of the jaws, a frame similar to those described for a 
single cast should be made, with both sides alike ; the wax 
is placed on each side, and the upper one pressed upon 
the gums, and holding it there the patient is directed to 
bring his jaw teeth together, w T hich will give the precise 
position of the mouth in mastication. Sometimes it is 
necessary to restrain the mouth from closing to its full 
extent, when there are no opposing teeth. 

It is also frequently necessary to take a transfer of one 
side at a time, to procure a correct representation of the 
gum, between molar teeth, when circumstances interfere to 
prevent a correct representation with a transfer of the 
entire jaw. 



17 



190 MECHANICAL DENTISTRY. 



TO MAKE A PLASTER MODEL. 

When a correct impression of the mouth is obtained, 
the frame in which it has been taken is to be surrounded 
with a strip of stiff paper, one inch or one and a half 
inches in width, and embedded in dry sand. £ ! 

The plaster, which should be previously finely bolted, is 
to be mixed with a sufficiency of water and poured 
gradually upon the slope of the wax, and allowed to flow 
gently into the indentations formed by the teeth. If 
any air has entered in pouring the plaster, it may be 
expelled by piercing it with a small wire or straw. When 
the plaster has set, which will be in the course of an hour, 
the wax may be again softened and carefully picked from 
the model, the teeth of which should be cleared first to 
prevent breaking them. 

If the model is wanted for immediate use, the drying 
may be hastened by mixing the plaster with hot water. 

To make a double cast, or articulator, the same process 
is to be pursued as in the single one, and one half of a 
hinge, made so that it may be disjointed, inserted into the 
plaster. When dry, the impression is to be inverted and 
the other half of the hinge connected, and also fastened 
into the plaster. 

The double cast will only answer the purpose of a guide 
for the relative position of the jaws, and cannot be 
depended on for fitting the plates. 

I generally use guides made of wax, as described in the 
making of whole sets, instead of the articulator, the only 



TO MAKE METALLIC DIES AND CAST. 191 

objection to which is the necessity for having the plates 
made before they can be taken, though I do not regard 
this as an objection, for generally it is desirable to try the 
plate to the gums before mounting the teeth on them, in 
order that any discrepancies may be remedied, which can- 
not so well be done after the plate is covered with the 
teeth. 



TO MAKE METALLIC DIES AND CAST. 

The dies are made of either brass or zinc ; the former is 
preferable, as it is less liable to injury in the process of 
s wedging. If zinc is used, it will be necessary to have 
two castings, the first one being more or less flattened on 
its prominences during the swedging. 

The model from which the die is to be made should be 
well dried in an oven (if a recent one) and trimmed regu- 
larly, with an incline from the base to the gum ; any 
hollows on its side surfaces should be filled with wax, 
otherwise it will not draw from the sand. 

A large tray or box to hold the sand, with a cover to 
exclude any dirt from getting into it ; a small box or flask, 
six inches square and three deep, with the lid and bottom 
piece disconnected, constitute the necessary apparatus for 
moulding. 



192 MECHANICAL DENTISTRY. 

Brass should be melted in a black lead crucible. Zinc 
and lead may be fused in an iron ladle, having one for 
each metal. 

To obtain the impression in the sand, place the plaster 
model in the flask, and fill it even with the top with fine 
sand ; to prevent any adhesion, a little pulverized rosin 
and charcoal may be sieved over the model ; press the 
sand as firm and solid as possible and invert the flask, 
exposing the base of the model, which may be drawn by 
inserting a gimlet into it. 

The sand should be dried before pouring in the metal. 

To make the counter, or female cast, place the die in 
sand, in an iron ring, and imbed it to the line on the cast 
that indicates the extent of the gum ; then pour upon it 
molten lead. 



CHAPTER IX. 



HAND LATHE. 

This is a convenient apparatus for the office or itinerant 
practice. Of the different constructions, the operator will 
find none more suitable than one of the following descrip- 
tion : consisting of an upright shaft, fastened to the table 
with a set screw, to which is also attached, from the 
centre, a pinion wheel of six inches in diameter, driving a 
smaller one of one inch, and secured by a screw on a 
mandril. At the head of the shaft to the end of the 
mandril, also retained by a screw, is fixed stones or emory 
wheels of any dimensions. 

An increased velocity is obtained by this combination, 
and the machine is worked easily by a handle riveted to 
one arm of the driving wheel. 



IT 



194 MECHANICAL DENTISTRY. 



PLATINA SHEARS. 



For cutting platina points for plate teeth of any required 
length, and at the same time flattening one end, as is 
necessary to hold it in the tooth, these shears will be found 
very serviceable ; they are capable of cutting six ounces of 
wire in one hour's time. 

Fig. 1, plate IV., exhibits the form, a is a check 
plate, which may be altered to suit any length intended to 
be given to the wire, by means of the screw with which 
it is fastened, b is a chisel-shaped tool, secured with a 
set screw, to excise the platina with, the remaining edge 
being flattened by the same process between the edges 
of the shears. 

This principle may be applied to a rotary engine fas- 
tened to the bench, by which a greater facility would be 
had in cutting the platina. 



HYDROSTATIC AIR PIPE. 195 

HYDROSTATIC AIR PIPE. 

The hydrostatic principle has long been applied to many 
useful purposes in the arts, but as an auxiliary to the 
mechanical dentist, in his fatigueing and health-destroying 
duties of soldering, will be found almost inestimable. I 
have tried a number of different inventions for the purpose, 
and have found objections to all. With the hydrostatic 
the operator has full command of the blaze, in quantity, 
force, and compass. 

Plate II., fig. 6, is a representation of one I have had 
constructed for my own use ; having a tin box four feet 
high and sixteen inches square, divided diagonally, (as 
represented by the dotted line,) with a vacuum of half an 
inch at the bottom. This box is half filled with water, 
which, with the bellows, is driven into the air chamber on 
the right. The muzzle of the bellows is furnished with a 
valve, to prevent the return of the air upon the inspiration 
of the bellows. A branch with an elastic tube, to which 
is attached the blow pipe, is soldered into the box near the 
top ; a small cock serves to admit the egression of the air 
as needed. A constant draught is maintained by working 
the bellows, which may be done with the hand or a 
treddle. 

The upright bar sustaining the bellows, can have 
attached to it a shelf for holding the lamp, or it may rest 
on a table. 

To prevent the tin from oxidating, it should be painted 
upon the outer and inner sides. The whole expense of the 
apparatus will not exceed fifteen dollars. 



196 MECHANICAL DENTISTRY. 

A spirit-lamp will be found preferable to oil; there is 
no smoke, and by the addition of one-tenth part of tur- 
pentine or pine oil to the alcohol, a very strong blaze of a 
good body is obtained. The tube containing the wick 
should be covered, when not in use, with a cap, to prevent 
evaporation, and the top of the lamp securely tight, to 
avoid combustion. The wick-tube should be of copper, 
or it will be likely to melt by the heat of the lamp. 



EMORY WHEELS. 

This material has almost entirely superseded the ordi- 
nary grindstone for cutting porcelain teeth, being made 
with more facility and at less expense, besides it is more 
efficient for the purpose ; to prepare it, take two parts of 
emory, the size to be determined by the grit required, and 
one part of gum shellac ; melt the gum over a gentle fire, 
and while in a state of fusion add the emory, working it 
in with a stick ; the addition of fine sand adds to the grit. 
Some care is necessary to avoid burning the gum, by 
which its tenacity is destroyed. A sand bath will be found 
a valuable auxiliary in the preparation of the composi- 
tion. 

Moulds may be made of brass or iron, of different sizes, 
and perforated through the centre, corresponding with the 
holes to be made in the wheels. After the composition 



EMORY WHEELS. 197 

cools in the mould, a heated wire may be passed through 
the hole and emory wheel. 

These wheels are secured upon small chucks adapted to 
a foot-lathe, and should be kept wet while in use, to pre- 
vent them from softening by the friction, and also to 
facilitate their cutting. 

Another method of making composition wheels, is to 
dissolve the gum in alcohol, and add the emory or sand 
until it forms almost a solid mass ; it is then transferred to 
the moulds and gently dried over a fire. The moulds 
should always be greased before using them, to prevent the 
material from adhering to them. 

The ordinary grindstone can be made with much facility 
from a stone of a laminated character, which may be split 
with a knife and hammer ; the stones are then laid out 
with a pair of compasses and chipped off with a chisel. 
They may be finished to a nicety in the lathe. 



198 MECHANICAL DENTISTRY. 

MANNER OF MAKING MOULDS. 

Moulds for porcelain teeth are variously constructed, 
and of different materials, of which brass is the most dura- 
ble and convenient to obtain. A pattern is generally made 
of plaster of Paris, from which a copy can be had in brass 
at any foundry. 

The original form given to the teeth was that of two 
bevils, thus dividing the tooth equally between the two 
halves of the mould ; the teeth, in consequence, were more 
liable to be broken in moulding, and the moulds were 
more difficult of construction. A much more natural form 
is now substituted, and one that admits of greater facility 
in making and finishing moulds, besides the teeth are 
recovered from the mould with less breakage ; it is by 
making the bevil from the posterior surface. 

To obtain a pattern, teeth are carved of bone, or of 
kaolin clay, and baked, with a flat bevilled base, agreeing 
in size and shape to those intended to be given by the 
moulds. A block is then made of mahogany or other 
hard wood, about five or six inches in length and one 
inch in width, finished perfectly smooth on one side, which 
is to represent the face of one half of the mould. A nar- 
row strip, about the eighth of an inch, is to be sprigged 
on it even with the side of the block, and bevilled to cor- 
respond with the base of the tooth ; the height of this 
strip must be equal to the thickness of the teeth. A box, 
or frame, is also made to enclose the block to hold the 
plaster, and resting on cletes fastened upon the side of the 



MANNER OF MAKING MOULDS. 199 

block ; this frame should be a little flaring, to give the 
pattern a form that will allow it to draw from the sand in 
making the impression for casting ; a sliding lid on the 
frame completes it. 

The teeth are now cemented on the block in proper 
order, and enclosed in the frame, which is to be filled 
with plaster of Paris mixed in water. When sufficiently 
dry, the frame is removed and the plaster taken from the 
block. By this process an impression of the front of the 
teeth is obtained. They are then taken from the block 
and placed in their relative positions in the plaster, which 
is again enclosed in a frame similar to the first, and the 
counter part made by the same process. Small indenta- 
tions should be made in the plaster, by which the moulds 
may be brought properly together when the teeth are 
removed. The surfaces of the wood and plaster should 
be oiled to prevent them adhering. 

After the brass moulds are finished, a piece of iron wire 
may be inserted in one end of each mould, and holes 
bored in the other ends to hold them in their proper places 
while moulding ; clamps are also necessary to fasten 
together the moulds. Finally, small holes should be 
bored to receive the platinas, uniform and true. 

Moulds for pivot teeth should be filed on the front sur- 
face, horizontal with the base or butt end of the tooth; 
holes are bored through of the same size as those to be 
made in the teeth, and wire fixed in a handle of a length 
that will admit it to penetrate far enough in the body of 
the tooth for the pivot. Two wires are necessary, one of 
a screw-shape to remove the extraneous body, and the 
other flat at the end to finish the cavity with. 



CONCLUDING REMAKES. 



EMPIRICISM— THE LETHEON— REPRODUCTION 
OF OSSEOUS MATTER— THE LIGAMENTUM 
DENTIUM— CONCLUSION. 

This is an age in which the purpose of man would 
seem to be to accomplish by deception and chicanery that 
which should only be the result of honest enterprise and 
industry. The influence exercised upon a credulous 
community by the myriads, in number and character, of 
reckless empirics, who pollute the moral and business 
atmosphere, has extended from one profession to another, 
until all have begun, alike, to feel its withering and 
destructive effects. None are exempt from it. The 
science of medicine, established as it is upon the only true 
basis, is constantly subject to the aggressions of men 
altogether ignorant of every principle that governs the 
human system, and consequently heedless of the result of 
their ministrations. By their colored and false misrepre- 
sentations they mislead their anxious subjects, until too late 
to retreat from the fatal snare. The dental profession has 
not escaped the blighting influence of such ; daily evi- 



CONCLUDING REMARKS. 201 

dences become manifest, not only of the deception 
practised, but of the ruin and irrecoverable destruction of 
those organs so necessary for the preservation of health, 
beauty, and comfort; it therefore becomes the duty of 
every man who enters upon the pursuit of a profession, by 
every means in his power to sustain it, in its dignity, its 
excellence, and in the practice of it according to scientific 
principles and candid revelations ; by such a course, only, 
can a system, having for its purpose the advancement of 
general good, be sustained. 

The too free adoption of every pretended discovery, 
plausible as it may at first seem to be, before it is subjected 
to the test of scientific investigation, savors of empiricism, 
and, as is unfortunately too often the case, is acknowledged 
and promulgated by those to whom subsequent inquiries 
prove the error and mistakes, that self-interest or pride 
forbid them to acknowledge. 

It is by experiment, and the application of known 
principles to new purposes, that any art, mechanical or 
professional, receives the impulse that gradually leads it to 
perfection ; to entirely discountenance which, would be at 
variance with the duty and requirements of all, whether 
immediately or indirectly interested. Therefore, when a 
discovery has withstood the necessary tests of its truth 
and applicability, it should be entitled to, and receive the 
reward of its merits. 

Public attention has been recently aroused by the 

announcement of a preparation procuring exemption from 

pain during the performance of severe surgical operations, 

the invention or discovery of Dr. Morton, a dentist of 

18 



202 MECHANICAL DENTISTRY. 

Boston. It operates by producing stupefaction, or a tem- 
porary paralysis of the nervous system, by which the 
patient, though conscious of all surrounding objects, is 
destitute of any sense of feeling. 

It is now generally conceded that this gas, to which has 
been given the name of " Letheon," is nothing else but 
sulphuric ether, highly volatilized, and inhaled from glass 
globes, furnished with valves to accommodate inspiration 
and respiration. The properties of sulphuric ether, 
according to " Wood and Bache," are, that it is a power- 
ful diffusible stimulant, though transient in its operations, 
and also anti-spasmodic and narcotic. Its vapour, when 
breathed from a bladder in which a few teaspoonsful have 
been put, produces a transient intoxication, resembling the 
effects of inspiring nitrous oxide, but very dangerous, if 
carried too far* 

It will at once be seen that the properties of this fluid is 
no new discovery, and it further appears that its use is 
highly dangerous. This fact is supported by the annexed 
statement, made by Dr. Hunt, of Washington City, D. C. 
He says : " Experience goes to prove that its use is far from 
being harmless. Some of those who have inhaled it were 
recently still suffering from its effects, after a lapse of days 
and weeks. I will cite a few cases, withholding, however, 
the names. One, of a lady who inhaled the gas in the 
latter part of December, was seized on the same day 
with a violent headache and irritation of the lungs; a 
week ago she was still suffering very much with the pain in 
her head, and on the slightest exposure, with a severe 
cough. Another lady, some ten or twelve days since, 



CONCLUDING REMARKS. 203 

inhaled the vapor, contrary to the advice of her physician 
(one of the first in jthe city). She went home that .day quite 
unwell, that night had to call in her physician, was con- 
fined to her bed sometime afterwards, and on Saturday 
(January r 30th,) had not recovered her usual health. 
Another lady was made c deathly sick,' to use her own 
expression, and for three days was laboring under an 
aggravated attack of nervous headache, to which she was 
subject, suffering much more than usual. A gentleman, 
well known in this city, inhaled the gas, and suffered for 
three days with violent headache. These persons all say 
that they could not be induced again to inhale the vapor. 
One lady, while inhaling it, was thrown into raving deli- 
Hum. The above are not mere rumors, but facts which 
can be substantiated. In addition, there is good reason to 
believe that the death of one, who promised to be an 
ornament to society, and a bright star in his profession, 
was hastened by the inhalation of the ethereal vapor, and 
that he went down to an early grave, one of its first 
victims in Washington. 

" With these examples before us, we are driven to the 
conclusion that the use of this gas is at least of doubtful 
propriety, and in this we are supported by distinguished 
members of the medical profession, in this and other cities, 
some of whom go farther, and say that it is dangerous." 

It is not my purpose to condemn, untried, the use of this 
preparation, but as, by its adoption, it is calculated to hold 
a very important position in dental practice, I have con- 
sidered it necessary to give some of the objections, and 
the authority, against its use. It will be proper to state 



204 



MECHANICAL DENTISTRY. 



that many very respectable medical and dental practitioners 
have subscribed to its usefulness and entire harmlessness. 

At page 20 of this work, reference is made to the asser- 
tion of John Wesley, that " the teeth, of all the bones, 
only grow in length during the whole life ;" since writing 
which, an article, copied into a periodical as emanating 
from the pen of Mrs. Child, and appearing originally in 
the New. Adv., has occurred to me, wherein she says : 
" A friend of ours had, when about twenty years of age, 
a front tooth that turned black, gradually crumbled, and 
broke off piecemeal. By frequently chewing charcoal, 
the progress of decay was not only arrested, but nature 
was set vigorously to work to restore the breach, and the 
crumbled portion grew again, till the whole tooth was 
sound as before." 

Not wishing to impute to the lady above quoted any 
intention of wilful misrepresentation, I can, nevertheless, 
believe she was either very much imposed on, or was 
deceived by circumstances unknown to her ; for example, 
one or both of the central incisores may be much decayed, 
so as to be apparent at a glance ; by a proper exercise of 
professional skill, in many cases, the carious portion may, 
in part, be filed away, and then filled so as to scarcely 
show any evidence of its former deficiency ; but that a 
formation of new bone and enamel, upon a tooth destroyed 
by caries, should take place, is in opposition to all physio- 
logical rules, and of which, to my knowledge, no writer 
or operator has ever pretended to have known a single 
instance. 

A few years since the dental profession was startled by 



CONCLUDING REMARKS. 205 

the pretended discovery of a " ligamentum dentium," by 
which the teeth were retained with all their firmness in the 
socket. It was only necessary to know the position of it, 
and the mode of severing it, to insure the extraction of a 
tooth " without pain." Of course there could exist no 
connection between the alveolar and the tooth, the perios- 
teum was but a gossamer web, that vanished into thin air 
the instant that the surgeon's knife entered the ligament, 
and a large molar tooth with three diverging fangs fell 
from its position at the magic touch. Strange as it would 
now seem, there were some whose credulity led them to 
acknowledge the truth of a declaration coined for specula- 
tive purposes, but with the larger portion it only excited 
the ridicule and contempt justly belonging to such a futile 
imposition. 

Before closing these remarks, it may be necessary to ask 
indulgence of the critical reader, for unintentional omis- 
sions, or errors, that may be found. The work was written 
during intervals between business hours, frequently after a 
day of fatigueing exercise ; and the -principal part of it 
while each preceding part was going through the press ; a 
mere synopsis or sketch being prepared at the start, to 
systemize, in some measure, the order and arrangement of 
the matter. 

As occasional reference is made to " Harris' Dental Sur- 
gery," it will be necessary to state that it is the first 
edition of that work to which allusion is made. 

It will also be observed, that for the convenience of 
those of the profession living remote from the cities, and 

frequently unacquainted with the location of artificers in 

18* 



206 MECHANICAL DENTISTRY. 

dental instruments and materials, an occasional individual 
is mentioned, though without any purpose derogatory to 
the reputation of others engaged in similar pursuits. Jus- 
tice to an old and tried arlizan in his branch, impels me to 
notice the name of Charles Abbey, of No. 24 Pear 
Street, Philadelphia, as a successful manufacturer of gold 
foil. 






J^^*?*Ji?w% 



LIBRARY OF CONGRESS 




DDOEbDbEEfl? 



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